Wound debridement

by Luan Nieuwoudt, Leonard Marais, Nando Ferreira & Thomas Hilton

Learning objectives

  1. Describe the pre-, intra- and post-operative principles concerning open fracture management and wound debridement.
  2. Discuss a stepwise approach to the intra-operative technique of wound debridement.

Case presentation

A 24-year-old male is brought to the emergency department following a pedestrian-vehicle accident (PVA). After excluding all acute life-threatening injuries, you conclude that he sustained an isolated open fracture of the left tibial diaphysis. The lower limb shows an 8cm x 4cm anterior-medial wound with exposed bone (Figure 1).

Clinical picture showing open fracture of tibial diaphysis with exposed bone fragments

Assessment History

Obtain a focused relevant surgical and medical history:


In terms of the local examination of the injured lower leg:




Special investigations


Pre-operative management

Pre-operative management entails primary management of the patient in the emergency department while undergoing fluid resuscitation. Control of haemorrhage can be obtained with direct compression on the wound as needed. The following steps must be taken:

Surgical or intra-operative management

Surgical debridement entails the sharp removal of all devitalised, damaged or infected tissue and foreign matter from a wound. Devitalised tissue and foreign material promote the growth of microorganisms, constitute a barrier for the host’s defence mechanisms and should be removed1. Wound debridement is the most critical aspect of open fracture management and should be done within 24 hours of the injury. Inadequate debridement usually leads to fracture-related infections or chronic osteomyelitis.

Early adequate surgical debridement is best done by an experienced team of healthcare workers, including an orthopaedic surgeon, in the following stepwise manner:

Post-operative management

Essential takeaways