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Débridement of Painful Cutaneous Ulcers: A Simplified and Painless Method

I. Jon Russell, MD, PhD; William A. Watson, PharmD
Arch Intern Med. 1984;144(9):1893. doi:10.1001/archinte.1984.00350210223052.
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To the Editor.  —Chronic cutaneous ulcers on the lower extremities are among the most difficult remedial problems faced by physicians because pain can prevent optimal débridement of fibrin from the ulcer bed. Juhlin et al1 previously suggested the use of topical anesthetics. The following procedure, using equal volumes of 2% lidocaine hydrochloride and 3% hydrogen peroxide, has seemed to promote healing by allowing relatively painless cleansing of cutaneous ulcers.A 25- to 50-mL syringe containing the irrigant was fitted with a 22- or 23-gauge needle through which a tangentially directed high-velocity stream bored its way under the layer of debris. While lidocaine provided local anesthesia, the bubbling of the peroxide lifted the detritus from the surface, allowing its removal with a saline solution irrigation, and occasional daubing with a gauze sponge. Finally, excess lidocaine was rinsed out of the ulcer bed to decrease the risk of neurotoxicity and


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