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Debridement in osteoarticular infections: my principles and everyday practice

On 01/10/2017
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Debridement in osteoarticular infections: my principles and everyday practice

By Gérard Giordano in category UPDATE
Hôpital Joseph Ducuing, Toulouse, France / [email protected]

If tissue debridement can be said to conform to a clear definition, its application in a technical sense is quite a different matter. This surgical step may initially appear quite simple, but as soon as you try to teach on the subject of osteoarticular infections, you soon realise the challenge: at best, our senior surgeons reply by talking about technical expertise–in other words, by giving their own personal ‘recipe’; either that, or they end up avoiding the issue. Maybe it is not really possible to give a precise answer.

Introduction

This article sums up my experience and thoughts gathered from 20 years of practice. It makes no claims to teach, just to share. For the benefit of our younger colleagues, I will attempt to explain this surgical step that is so fundamental to the successful management of infection, and how, as surgeons, they can apply a reproducible and efficient technique. I have happily restricted my report to debridement in periprosthetic hip and knee infection. There is one thing I need to clarify: in this article, ‘debridement’ should be understood in the English sense of the word¾excision.

 

A precise definition … and some questions 

Surgical debridement may be defined as an ‘exhaustive and economical excision of all contaminated, infected, dead or dying tissue, together with the removal of all actual or potential foci of infection’. Taking this definition point by point, what does it imply?

  • Exhaustiveness presupposes an ability to recognise an infected tissue on a macroscopic level, by comparison with the usual normal appearance of that tissue, whatever its type (skin, fascia, muscle, tendon, bone, cartilage). But has our education really trained us to do that or is it more a matter of personal experience? What I believe is that we are taught by our mentors, and so...

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