Saadia R, Schein M
Department of Surgery, University of Manitoba, Winnipeg, Canada.
World J Surg. 2000 Sep;24(9):1146-9. doi: 10.1007/s002680010188.
Débridement is a well established modality for management of gunshot wounds. The word "débridement" is originally French. It was used for the first time during the eighteenth century in the surgical context and meant "wound incision." For French surgeons, it has retained to this day its original meaning. In medical English, though, the use of the term has been marred by persisting confusion about its definition. Two quite different surgical procedures still compete for the definition of débridement: wound incision and wound excision. These procedures are also at the center of a modern controversy about the management of gunshot wounds. The orthodox doctrine, inherited from military surgeons, consists of aggressive tissue excision around the bullet track. This radical policy is being challenged by advocates of a more conservative approach. Minimal tissue excision is sufficient and safe in many cases provided careful monitoring of the wound is instituted. Wound incision alone to relieve tension and allow drainage is possible in certain cases. The tug-of-war between excision and incision is outlined herein with reference to the semantic tribulations of the word "débridement" and the implications for patient care.
清创术是一种成熟的枪伤处理方式。“清创术”一词源于法语。18世纪它首次在外科领域使用，意为“伤口切开”。对于法国外科医生来说，至今它仍保留着其原义。然而在医学英语中，该术语的使用一直因对其定义的持续混淆而受到影响。两种截然不同的外科手术仍在争夺“清创术”的定义：伤口切开和伤口切除。这些手术也是现代关于枪伤处理争议的核心。从军队外科医生那里继承来的正统学说包括对弹道周围进行积极的组织切除。这种激进的政策正受到更保守方法倡导者的挑战。在许多情况下，只要对伤口进行仔细监测，最小限度的组织切除就足够且安全。在某些情况下，仅进行伤口切开以缓解张力并实现引流也是可行的。本文结合“清创术”一词的语义困境以及对患者护理的影响，概述了切除与切开之间的争论。
