Wound Debridement in Remote Settings

Injuries in remote settings like a wilderness trail or survival homestead pose challenges to the medic not experienced in long-term wound care. Ordinarily, a system exists to evacuate victims of such injuries to modern medical facilities. In situations where that option doesn’t exist for the foreseeable future, however, the average person may be medically responsible from the point of injury to full recovery.

This is a novel (and sobering) thought for most, and the tools needed to provide regular wound care and the medications to prevent and treat infection may not be at hand. For this reason, I have spent years writing articles on the importance of antibiotics as part of a prepared individual’s medical supplies.

Although I’ve written extensively on antibiotics in survival settings, I’ve written less on wound debridement. Originating from the French “desbrider (to unbridle), debridement is the act of removing dead or foreign material in and around a wound.

Debridement was likely first discovered to be a useful medical tool in wartime, where grossly contaminated wounds were common. The horrific wounds incurred in armed conflict seemed to do better if damaged and dead tissue was aggressively removed. This tissue may be on the edges or throughout the injury. It usually appears discolored, often blackish with a foul odor, although it could also appear white.

By removing dead tissue that, by definition, will not heal, you eventually reach a level where live tissue exists. After debridement, the remaining tissue can recover in a cleaner environment or might, in certain circumstances, be a candidate for wound closure.

Why Should You Debride a Wound?

Despite the benefits of debridement, some less-trained survival medics might (understandably) be reluctant to intervene. It is important for them, therefore, to understand the detrimental effects of allowing non-viable tissue to remain in an open wound.

The first is lack of exposure. An open wound is best evaluated when all the dead tissue is removed and the amount of viable material is known.

Next is the suppression of the healing process. Tissue that is no longer viable serves as a place for bacteria to grow, especially the nasty ones that cause serious issues like gangrene. These bacteria slow the healing process in open wounds by competing with growing cells for nutrients.

Necrotic (dead) tissue also causes inflammation in nearby tissues and increases the chance of sepsis (a body-wide infection).

Finally, failure to remove non-viable tissue interferes with the ability of live tissue to naturally close an open wound (a process called granulation).

Removal of non-viable tissue by debridement and treatment with antibiotics helps a wound to heal, but either treatment alone does not give you the best chance of avoiding infection, according to studies cited in a recent issue of Wilderness and Environmental Medicine (2017; Vol. 28, #2S).

The above article referenced an evaluation of open fractures, a severe injury found in both wilderness and survival settings. The results seem to show that surgical intervention and antibiotics given within 2 hours is associated with the lowest rate of infection. When antibiotics are given on time but surgery is delayed, higher rates of infection are seen. When surgical intervention occurs on time but antibiotics are delayed, even higher rates are noted, although signs of infection may not appear for three days or so.

Wound Debridement in Survival Settings

There are various ways to debride a wound, but only the following, in my opinion, would be options in a survival scenario:

Sharp Debridement: Using a scalpel and scissors, dead tissue can be quickly removed. Some surgical skill is useful for the best results.

Mechanical Debridement: Aggressive wound irrigation helps remove debris and leads to a cleaner wound, but results aren’t as complete or as rapidly seen as with sharp debridement. Less skill is required, however, to achieve the end result.

Biological Debridement: Maggot therapy. The larvae of the green bottle fly is used to digest dead tissue and bacteria. One way to collect maggots is to place, say, a dead rat or squirrel in a bag with small holes at the bottom and hang it over a plate or pan to collect the maggots that fall out after a few days. More on maggot therapy in a forthcoming article.

Your goal in debriding a wound is to have clear margins of live healthy tissue on all sides. This tissue will bleed somewhat (a sign of life!), but is unlikely to hemorrhage. Moist dressings should then be used to cover the wound and changed regularly.

Debridement takes place at modern facilities in normal times. In survival scenarios, the procedure should take place where there is good lighting (and the bulk of your medical supplies). Having an assistance to help is always a good idea. In the inexperienced, the anatomy of a deeply necrotic wound may be unclear; the medic should have a good textbook on anatomy in their survival library and learn as much as possible before a long-term disaster takes place.

Bottom line: Live tissue heals, dead tissue doesn’t. Debridement allows you to remove the dead material so the live tissue can heal.

Joe Alton MD

Find out more about long-term wound care in austere settings by getting a copy of our 700 page Third Edition of The Survival Medicine Handbook: The Essential Guide for When Medical Help is Not on the Way. Also, fill those holes in your medical supplies by checking out Nurse Amy’s entire line of medical kits and supplies at store.doomandbloom.net.