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Debride and See: Use of Uterine Curette for Wound Bed Debridement before Skin Grafting

Duek, Ori Samuel*; Shoufani, Aziz

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Plastic and Reconstructive Surgery - Global Open: March 2018 - Volume 6 - Issue 3 - p e1680
doi: 10.1097/GOX.0000000000001680

Surgical debridement is not a new technique and has been described in historical texts of ancient times.1 However, while removing devitalized tissue is undoubtedly essential for wound healing, debriding granulation tissue before skin grafting is more debatable, though still a common practice.2

Most reconstructive surgery departments and burn centers in Israel use the spoon curette to aid in debriding a wound prior to skin grafting, in an effort to take off colonized granulation tissue and reduce the bacterial load of the wound bed.

In Emek Medical Center in Afula, Israel, we use a different instrument—a Sims Uterine Curette.

As shown in the attached video, using this curette enables more elegant and precise maneuvers, demonstrating a faster method to prepare the wound bed for the awaiting skin graft (see video, Supplemental Digital Content 1, which displays wound bed debridement using the uterine curette, https://links.lww.com/PRSGO/A715).

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Video Graphic 1.:
See video, Supplemental Digital Content 1, which displays wound bed debridement using the uterine curette, https://links.lww.com/PRSGO/A715.

The spoon curette is smaller and closed on 1 side, to collect and remove debrided tissue off the wound bed. However, its head is too small to efficiently carry all the debrided material. The larger uterine curette has a sharp teardrop shaped loop tip, available in various sizes. It covers a larger area and enables a direct view on the debrided tissue during curettage. Hence, results are achieved in fewer curettage strokes. The debrided tissue is easily taken off with a dry gauze, and the wound is ready for skin grafting.

Sometimes, though, the gynecologists wonder where all their curettes have gone.

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Fig. 1.:
Debridement results using the uterine curette. A, Before debridement. B, After debridement.

REFERENCES

1. Lyons AS, Petrucelli RJ. Medicine: An Illustrated History. 1987.New York, NY: Henry A. Abrams Publications.
2. Fowler E, van Rijswijk L. Using wound debridement to help achieve the goals of care. Ostomy Wound Manage. 1995;41:23S–35S; discussion 36S.

Supplemental Digital Content

Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.