Many chest wall surgical diseases have wounds in the chest wall, such as chest wall infections, incision infections, etc., and there will be wounds. These wounds are basically infectious lesions, and there may be specific lesions such as: local lumps, abscesses, incisional fissures, fistulas, full-thickness infection of the incision, osteomyelitis, etc. If the infection is not controlled, the spread of the infection will occur. In order to control the infection and eliminate the lesion, the lesion needs to be treated clinically, and the most basic treatment is debridement. Debridement is at the heart of all types of wound treatment.
In general, debridement includes the following basic contents: (1) thorough disinfection. The operating table, wound and inside the wound must be fully sterilized. Every operation must be carried out strictly in accordance with the principle of sterility; (2) complete removal of necrotic tissue. Necrotic tissue within the wound and the structure of suspected necrotic tissue are completely removed; (3) the foci of infection are completely removed. Infected tissues, secretions and other structures must be completely removed; (4) completely remove all foreign bodies. All sutures, wires and other materials within the wound must be completely removed.
After debridement is complete, close the incision. There are also special requirements at this time. The specific requirements are: (1) can not be reconstructed with foreign objects. During debridement, some structures are removed and may need to be reconstructed after surgery, but if artificial materials are required to rebuild, it is equivalent to adding foreign bodies in the wound, which must be avoided; (2) completely eliminate the dead space. The dead space can retain secretions and necrotic substances, becoming a dead end of treatment, which cannot exist in the wound, otherwise it will seriously affect the treatment effect; (3) adequate drainage. There will be a continuous discharge on the wound after debridement, and such secretions must lead out of the wound, otherwise it will affect the healing of the wound; (4) dilation and suturing. Since the skin of the wound may be removed locally, if the skin of the wound is tense after surgery, it is necessary to reduce the tension and suture; (6) Strengthen nutrition. The presence of wounds often causes systemic depletion, and the patient's systemic condition needs to be adjusted after surgery to meet the needs of wound healing; (7) anti-infective treatment. Postoperative anti-infective therapy is an essential measure to consolidate efficacy and must be treated with effective antibiotics.
The presence of chest wall wounds is a great challenge for every chest wall surgeon, and great efforts must be made to achieve good results. For mild wounds, proper treatment allows for effective control. But some of the wounds were extremely serious and stubborn, and despite a lot of effort, there were still no good results. At this time, it is necessary to reflect deeply on the technology, and only in this way can it ultimately be successful.