Sharp Debridement of Wounds Series, vol. 2, Anatomy and Assessment of the Torso.

Wethe JD, Sussman C, Fowler E. Torrance, CA 90505, Sussman Physical Therapy Inc, 1995, VHS, approximately 21 min, $99.95.

The purpose of this videotape series is to allow viewers to observe various sharp debridement techniques and the anatomy of commonly debrided sites. Each of the tapes is accompanied by a printed manual that outlines the contents of the video presentation and provides an overview of the major points contained in the video demonstration. These manuals are not meant to stand alone as dissertations on wound debridement. The videotapes, however, serve as succinct demonstrations of basic principles of sharp wound debridement.

The first videotape provides an introduction to and a basis for the use of sharp instruments, including types of instruments and selection of tools. Debridement of various types of tissue is shown. The techniques of scoring, removal of eschar, debridement of fat muscle and tendon, and shaving of fascia are demonstrated. Mention is made of suitable preparation for the sharp debridement, including set of the field, collection of supplies, lighting, patient positioning, and identification of need for assistance. Proper disposal of tools is also discussed.

The videotape then provides an example of the actual debridement of a diabetic foot ulcer. Although this debridement took place in a surgical setting, the principles discussed earlier are appropriately reviewed during this demonstration. This videotape also provides illustrative examples of different types of wounds that lend themselves to sharp debridement.

The main focus of the second videotape is to review the anatomy of the torso and demonstrate the rationale and precautions for sharp debridement in this region. Examples of the types of wounds that are often debrided and indications for sharp debridement begin the videotape. The majority of this videotape is devoted to the prosection of the hemipelvis. The purpose for this prosection is to impress upon the viewer the importance of identifying tissues and structures that may be debrided versus tissues (nerve, muscle, vascular) that must be avoided. The prosection also serves to remind the viewer of the appearance of different tissues (eg, skin, fat, bone nerve, muscle). Before-and-after examples of sharp debridement of necrotic wounds in this region end this videotape.

The third videotape focuses on the anatomy and assessment of wounds of the lower extremity. The organization of this video is similar to that of the second. Common wound sites, identification of necrotic tissue, and cadaveric prosection of the lower extremity are presented. Before-and-after examples of wounds are also provided. Again, the prosection serves as an Important reminder to the viewer of the caution that should be exercised when performing sharp debridement.

This third videotape also contains interesting and well-presented demonstrations of the debridement of necrotic tendon, with reference to the functional importance of the structure and the level of care that should be rendered when debriding this structure. There is also a very good demonstration of the shaving, or excision, of callus on the planter surface of the foot. This is presented in relation to a planter ulcer, but it has treatment implications for many other foot wounds and conditions. The only drawback is that if the entire series is viewed, the third videotape ends with a repeat of the same presentation on debridement of a diabetic foot ulcer that ended the first videotape.

The series provides good demonstrations of technique, types of wounds, and pertinent anatomy. The narration adds to the learning experience. Visual overlays (eg, depicting anatomical structure) are used with discretion and further contribute to the instruction. The demonstrations are well paced and clearly performed.

This videotape series would provide a nice review for clinicians involved in wound care and would be an admirable teaching adjunct in both a wound care clinic or an academic institution.

R Scott Ward, PhD, PT University of Utah Salt Lake City, Utah 

Dr Ward is Co-Director of the Division of Physical Therapy and is a member of the staff of the Intermountain Burn Center. He is active in research and publication in the area of burn care and cutaneous sensory innervation.