THE PRINCIPAL treatment of massive and open wounds in combat is debridement—removal of dead tissue and foreign bodies. This treatment minimizes infection. However, in a military situation debridement may be delayed for a period of six to 24 hours or longer. This has occasionally been the case in Vietnam, due to prevention of helicopter evacuation by hostile fire or adverse weather, or both. Wounds untreated for this length of time become infected. What can be done for the wound during the delay period? At present, application of a dressing is the only procedure employed or recommended. These findings have recently been corroborated (R. M. Hardaway, MC, unpublished data).
Analysis of cultures from the wounded nationals in Vietnam revealed that Pseudomonas, Staphylococcus, and group-D Streptococcus are three major microorganisms. Clostridial infection is rare although clostridial organisms are usually present.
The main advance in local wound treatment since the American Civil