Special Operations Forces Medical Handbook

8-26

Abrasions
Particular attention should be given to abrasions in order to prevent a traumatic tattoo. These occur when
fine particles become embedded and are incorporated into the epithelium.

1. Ensure adequate anesthetic has been administered (either locally or via block).


2. Xylocaine gel can be applied to the wound for 5-10 minutes. This may assist in providing adequate
   anesthesia.


3. Irrigate the abrasion copiously with NaCl.


4. Use a sterile toothbrush or surgical scrub brush soaked with NaCl or surgical soap to help remove
   the debris.


5. Use the tip of a #11 blade to remove large or deeply embedded particles.


6. Use mineral oil, Vaseline, peanut butter, or mayonnaise (or some other oil-based product) to
   help remove tar.


7. Leave the wound open and clean it daily.

Penetrating wounds

1. Use a scalpel with a #11 or # 15 blade to excise the entry and exit wounds. The incisions should be
   sufcient to allow optimal surgical exposure and drainage. The excised skin should include the
   underlying subcutaneous tissue, and be incised oriented parallel to the underlying muscle ber.


2. Incise the fascia parallel to the muscle ber with Mayo or Metzenbaum scissors in both directions.
   Open the muscle surrounding the missile tract in the direction of the bers to allow adequate exposure
   for inspecting the tract.


3. Inspect the wound tract. Remove any foreign bodies. Excise any muscle that is compromised and
   nonviable with a scalpel or scissors.


4. Utilize the retractors at this time to help with visualization and debridement. Be careful when using
   retractors in order to avoid damaging vessels, nerves, and healthy tissue.


5. Perform this procedure at both the entry and exit wounds. Debride the mid-track through extended
   entry and exit wounds. This prevents cutting across muscle groups to connect the two wounds.


6. Appropriate drainage of the wound may be difcult to achieve. Liberal incisions tend to facilitate
   drainage from the deep recesses. Remember to excise skin, fascia, vessels, nerves, and bone
   conservatively, and muscle more liberally. Try to save periosteum and tendons unless severely
   contaminated or compromised.


7. Irrigate the wound copiously again as above.


8. Do not pack the wound. The additional pressure can cause tissue necrosis, due to its already
   compromised blood supply. Lightly lay dry sterile gauze in the wound.


9. Leave the wound open with delayed primary closure in 4-10 days.

What Not To Do:
Do not debride good, viable tissue. Wait until the tissue declares itself, or makes it apparent that it is dead.
Do not close the debrided wounds, but let them drain. They may be closed later (delayed primary closure)
if not infected.
Do not pack debrided wounds tightly, but allow them space to expand.

Procedure: Skin Mass Removal

Maj. Frederick Shuler, USAF, MC

What: Surgical procedures for treating various masses and conditions of the skin including abscess,
epidermal inclusion cyst (EIC), lipoma, mole, etc. These masses may be inflamed (abscess) or non-inflamed
(lipoma).

When: The patient complains of a mass in the skin that is either infected or a hindrance to activity and
mission performance. Manage lesions that do not fit into these categories conservatively until return from the
mission. The medic should not remove vascular masses.
Non-inflamed: These are best treated electively with excision (the removal of the entire lesion) and submis-