An evaluation of the surgeon's criteria for determining the viability of muscle during débridement.

Abstract

One of the prime requisites of adequate initial surgery in war wounds is the removal of all devitalized tissue. When this is accomplished, delayed primary closure can be carried out in four to six days. On the other hand, if devitalized tissue and, especially, dead muscle are allowed to remain, bacterial growth is fostered and local infection, clostridial myositis, septicemia, and even death may ensue. Although adequate debridement of a wound depends to a great extent on the operator's ability to distinguish viable from dead muscle, experienced surgeons differ as to the criteria of greatest reliance. Their criteria are based more on personal impressions of how wounds behave postoperatively than on any direct studies of the muscle tissue itself. Thus, although a surgeon may acquire great skill in debridement by dint of personal experience, it may be difficult for him to explain to the uninitiated the precise reasons why he