WOUND DEBRIDEMENT / MINOR OPERATION NOTE

Patient: ________________
Identifier: ________________
Date: ________________


PROCEDURE AND TEAM
Procedure performed: ________________
Procedure date and time: ________________
Urgency: ________________
Indication and preoperative diagnosis: ________________
Postoperative diagnosis: ________________
Surgeon and assistants: ________________
Anaesthesia and anaesthetist: ________________
Consent and safety checks: ________________

WOUND ASSESSMENT
Site and side: ________________
Pre-procedure dimensions / depth: ________________
Tissue appearance / contamination: ________________
Neurovascular and adjacent structure assessment: ________________

PROCEDURE
Debridement method and extent: ________________
Post-procedure dimensions / deepest tissue removed: ________________
Irrigation and haemostasis: ________________
Closure / packing / dressing: ________________
Antibiotic and tetanus assessment / actions: ________________

COMPLETION AND HANDOVER
Specimens and labels: ________________
Estimated blood loss (mL): ________________
Instrument / swab / needle counts: ________________
Complications and response: ________________
Condition and destination: ________________
Postoperative instructions and responsible team: ________________

Clinician: ________________
Signature: ________________

WOUND DEBRIDEMENT / MINOR OPERATION NOTE
FICTIONAL EXAMPLE - NOT FOR CLINICAL USE
Illustrative content only; not a clinical reference.

Patient: FICTIONAL PATIENT
Identifier: DEMO-001
Date: 01 January 2026


PROCEDURE AND TEAM
Procedure performed: Debridement of superficial lower-leg wound (fictional).
Procedure date and time: 01 January 2026, 09:00 (fictional)
Urgency: Urgent
Indication and preoperative diagnosis: Left lower-leg wound with devitalised skin and subcutaneous tissue.
Postoperative diagnosis: Left lower-leg wound with devitalised skin and subcutaneous tissue.
Surgeon and assistants: Dr Demo A; Dr Demo B (fictional)
Anaesthesia and anaesthetist: Technique recorded in the separate anaesthetic chart; Dr Demo C (fictional).
Consent and safety checks: Consent, identity, procedure and site checks documented in the fictional theatre checklist.

WOUND ASSESSMENT
Site and side: Left anterior lower leg.
Pre-procedure dimensions / depth: 3 x 2 x 0.3 cm; skin and subcutaneous tissue involved.
Tissue appearance / contamination: Devitalised wound-edge tissue; no exposed tendon or bone.
Neurovascular and adjacent structure assessment: Distal perfusion and sensation documented before the procedure.

PROCEDURE
Debridement method and extent: Devitalised tissue removed with sharp debridement to the documented viable margin.
Post-procedure dimensions / deepest tissue removed: 3.5 x 2.5 x 0.4 cm; subcutaneous tissue was the deepest layer removed.
Irrigation and haemostasis: Irrigated; haemostasis obtained.
Closure / packing / dressing: Left open with a non-adherent dressing; no packing.
Antibiotic and tetanus assessment / actions: Individual assessment and any prescribed medicines documented separately.

COMPLETION AND HANDOVER
Specimens and labels: Specimen details recorded with site and destination.
Estimated blood loss (mL): 20
Instrument / swab / needle counts: Confirmed complete at closure.
Complications and response: None observed during this fictional procedure.
Condition and destination: Transferred to recovery with a documented handover.
Postoperative instructions and responsible team: Individual orders, monitoring, wound review and follow-up to be prescribed by the responsible team.

Clinician: DEMONSTRATION ONLY - NOT SIGNED
FICTIONAL EXAMPLE - NOT FOR CLINICAL USE