IN FLANDERS-FIELDS - THE GREAT-WAR, DEPAGE,ANTOINE, AND THE RESURGENCE OF DEBRIDEMENT

Objective The care of traumatic wounds has evolved over hundreds of ye ars, largely as a result of armed conflicts. The lessons learned durin g World War I in the treatment of extensive soft-tissue injuries prove d invaluable in reducing infection and preventing loss of limb nad lif e. Foremost among these was the use of debridement. This report review s the development of debridement as standard treatment of war wounds a nd highlights the surgeon largely responsible for its resurgence durin g one of this century's saddest chapters. Summary Background Data Befo re World War I, the care of wounds consisted of minimal exploration an d liberal use of then-new antiseptics. For limited injuries, this appr oach appeared adequate. World War I saw the introduction of devastatin g weapons that produced injuries that caused extensive devitalization of tissue. Standard treatment of these patients proved woefully inadeq uate to prevent life-threatening infections. Methods This is a histori cal review of the conditions that occurred during World War I that pro mpted a change in wound management. One of those responsible for this change was Belgian surgeon Antoine Depage. His life and contributions to the care of war wounds are profiled. Depage reintroduced the discar ded French practice of wound incision and exploration (debridement) an d combined it with excision of devitalized tissue. Results Through the use of debridement, excision, and delayed wound closure based on bact eriologic survey, Depage was able to reduce the incidence of infectiou s complications of soft-tissue injuries, particularly those involving fractures. Conclusions Through his experiences in the Great War, Antoi ne Depage was able to formulate a treatment plan for wounds of war. Al l such injuries were assumed to be contaminated and, as such, they req uired early and careful debridement. Depage thought that wound closure should often be delayed and based his decision to close on the bacter iologic status of the wound. To him, we owe our current management of traumatic wounds.