When you think of the surgeries depicted on MASH, what do you think of? Open chest surgeries? Abdominal surgeries, such as repairing or resecting a bowel? Arterial graphs? These were featured on MASH because they are dramatic and intense. But, besides resections or grafts, another word we hear on MASH would be a word more often used in a real MASH: debridement. Debriding wounds was constantly required during the Korean War. This procedure also illustrates a misunderstanding about surgery in battlefield environments, as reflected in a question I saw on Reddit recently.
Why Do Surgery on a Minor Wound?
A Reddit user (I don’t remember the specific thread) was remembering a MASH episode in which Hawkeye operates on a wounded soldier and then tells him later in post-op that he had a minor wound. Why, the user asked, would the fellow have been operated on if his wound was so minor?
This is a great way for us MASH fans to begin to understand the reality of battlefield wounds. First, a “minor” wound in a battle is not what you or I would consider minor. It would be horrific by our everyday standards. Second, even if a soldier suffered a relatively minor laceration, it could be many hours, if not days, before the wound was treated. It also may have been contaminated with filth, dirty water, etc.
By the time such a patient reached a MASH unit, some of the tissue at the edges of the wound would have begun to die and become necrotic. If the wound was deep other tissues, such as muscle, would begin dying due to the lack of blood supply. This, in turn, introduces infection. Such a wound cannot be simply sewn shut. It requires debridement. While routine, this would still be done in the operating room, and it is still a type of surgery.
Surgical debridement not only involved the removal of injured and dying tissue, but also blood clots and foreign bodies. As well, the procedure would include the control of any bleeding. Debridement helps to halt the destructive processes that occur after a battlefield wound and helps the body begin its repair process. 1Bronwell, Alvin W., et al. “DEBRIDEMENT.” AMEDD Center of History & Heritage, achh.army.mil/history/book-korea-recad1-ch5-3. Accessed 3 Dec. 2025. From: RECENT ADVANCES IN MEDICINE AND SURGERY (19-30 APRIL 1954) BASED ON PROFESSIONAL MEDICAL EXPERIENCES IN JAPAN AND KOREA 1950-1953 VOLUME I U. S. ARMY MEDICAL SERVICE GRADUATE SCHOOL WALTER REED ARMY MEDICAL CENTER WASHINGTON, D. C.
Debridement with Delayed Primary Closure
While on the show, wounds were depicted as being closed as soon as they were debrided; in reality, a procedure called “delayed primary closure” was preferred. This is definitely something that a civilian surgeon would find counterintuitive, something that is portrayed on the show at least once, although perhaps not intentionally.
Instead of debridement and closure of wounds, the standard treatment at a MASH unit in Korea was debridement only, whenever possible. Full closure could wait until the patient was transferred to another hospital. Why does this make sense?
First, the use of helicopters and forward-located MASH units themselves decreased the time between injury and treatment vastly during the Korean War. This was also the first time that antibiotics were available throughout a patient’s journey, from the moment they were injured and throughout their treatment and recovery. The average time from injury to surgical treatment decreased vastly. Up to 58% of wounded soldiers received treatment within two hours of injury, and 85% were treated within six hours.
The availability of penicillin and sulfa-based drugs to decrease the infection rate caused many new surgeons in Korean MASH units to become over-confident, and they thus failed to debride and close wounds too early. Infections and other post-operative complications increased dramatically. These surgeons had to relearn the lessons learned in previous wars and realize the importance of the debriding procedure. Should a patient be unnecessarily closed at the MASH, this would only cause more problems down the line. 2Gabriel, Richard A.. Between Flesh and Steel: A History of Military Medicine from the Middle Ages to the War in Afghanistan. United States, Potomac Books, 2013.3Orthopedics in Disasters: Orthopedic Injuries in Natural Disasters and Mass Casualty Events. Germany, Springer Berlin Heidelberg, 2016.
Once a wound was debrided and closed, the next medical team would not be aware of the nature of the injury. Any problems were closed up! Captain Bronwell, MC, et al. explains:
Definitive surgery cannot be carried out in the forward hospital initially because: (1) usually the time lag is longer for war casualties than for civilian casualties; (2) after initial treatment, a war casualty must be evacuated at an early date to a hospital further to the rear, thus making it impossible for proper immobilization of the injured area; and (3) because of evacuation, the patient must be cared for by various physicians. These physicians cannot be as familiar with the condition of the wound as the surgeon who treated the patient initially. Careful postoperative observation for wound infection, excessive swelling, or necrosis of injured tissue is impractical during transportation. 4Bronwell, Alvin W., et al. “DEBRIDEMENT.” AMEDD Center of History & Heritage, achh.army.mil/history/book-korea-recad1-ch5-3. Accessed 3 Dec. 2025. From: RECENT ADVANCES IN MEDICINE AND SURGERY (19-30 APRIL 1954) BASED ON PROFESSIONAL MEDICAL EXPERIENCES IN JAPAN AND KOREA 1950-1953 VOLUME I U. S. ARMY MEDICAL SERVICE GRADUATE SCHOOL WALTER REED ARMY MEDICAL CENTER WASHINGTON, D. C.
That last part may require some illumination. It is easier to observe any changes in a wound during transportation if the wound is still open. Infection, necrosis, and swelling are more apparent if the wound is not closed with sutures. This is why the definitive procedure for battlefield wounds during the Korean War was “debridement with delayed primary closure.” So, MASH got it half right.
The Reddit question above is easily answered by describing only one part of debridement: The skin. Debriding of the skin requires 1) an incision to enlarge the wound and expose the depth and full extent of the wound, and 2) the excision of dying skin. Even without knowing anything else about the procedure, we see that this is indeed a surgery. Even a “minor battlefield wound” would require a bit of surgery to treat properly.
It would not be necessary to tell anyone to “debride the wound” in a battlefield hospital like the 4077. However, the series did not show the actual operations. We had to follow along through the dialogue. The word debride was used numerous times, including in the pilot episode. Below are some examples.
The Surgical Technique Debridement Mentioned on MASH
Season 1, Episode 1 – Pilot: Hawkeye is narrating a letter to his Dad, interspersed with scenes from the O.R.
Hawkeye: We work fast and we’re not dainty, because a lot of these kids who can stand two hours on the table…just can’t stand one second more. We try to play par surgery on this course. Par is a live patient.
Hawkeye in the O.R.: Clamp
Nurse: Clamp
Hawkeye: I’ll debride the wound, then we’ll go in after the spleen, okay?
Season 3, Episode 15 – Bombed: The unit is being bombarded, but HQ claims it is not. Things are a mess. A generator is down, and so is the water tank. Three injuries have occurred, and to top it off, wounded are arriving and bombs are hitting close to the hospital building and blowing out windows. In the O.R., while Henry and Hawkeye are trying to restrain and sedate a distraught Chinese soldier, Henry tells Hawkeye he needs to go to the latrine. In the midst of the chaos, a large bomb goes off close by. Then, a panicked Radar comes in:
Radar: Somebody, come quick!
Frank Burns: What happened?!
Radar: It’s Col. Blake! He’s in the latrine!
Hawkeye: Hurray for regularity.
Radar: It’s been hit! He’s trapped!
Hawkeye: Debride the wound.
Margaret: Kelly, I need clean gloves!
Season 4, Episode 23 – Deluge: Klinger and another enlisted man are cleaning the large mess hall kitchen sink to get it ready for a patient who has phosphorus burns on his leg from white phosphorus ammunition. They must immerse his leg in water to keep the phopspurus away from the air, lest it ignite. Then they must apply sulfur so that the phosphorus glows in the dark. Hawkeye and B.J. come into the kitchen along with two men carrying the patient.
Klinger: You really gonna operate in the sink?
B.J.: We have to work underwater. He’s got phosphorus burns.
Hawkeye: It’s in the tissues. If it hits the air, it can ignite. Next thing, you got G. I. Flambe.
Klinger: The guy could catch on fire? Wow.
Hawkeye [to nurse] We’re gonna need more sulfa powder.
Nurse: We’re low on sulfa.
Hawkeye: We’ve got enough saltpeter for World War IX.
Nurse: Does that stuff really work?
Hawkeye: Search me, fella.
Klinger: What’s happening?
B.J.: Cleaning the wound. Debriding the necrotic or loose tissue.
Klinger: I don’t know how you guys do it.
Hawkeye: Helps a little if you think you’re God.
Incidentally, the procedure for removing the phosphorus is the cause of a continuity error during Season 10, in Episode 16, titled Pressure Points. In this episode, a visiting Captain presents white phosphorus ammunition as a new threat and explains the complex procedure for removing it, as if the unit had never seen it before. Not only is this a continuity error, but it is an error in historical fact, as white phosphorus had been used since World War I.
Regardless, in the former episode, we see that even something as dramatic as removing phosphorus fragments from a patient’s tissues still involved the same basic procedures of debridement.
Hawkeye Questions Not Closing the Wound
In Season 8, Episode 20, titled Lend a Hand, we see Hawkeye questioning another doctor about the wisdom of leaving a wound open for a surgery to be performed later. The consultant, Dr. Anthony Borelli (Robert Alda), is visiting the 4077 again, much to Hawkeye’s annoyance.
Hawkeye volunteers to go fill in at the battalion aid station to treat the badly injured doctor there, Captain Kramer. He wants to avoid the surprise party after B.J. “borrows” his birthday to boost morale, and to avoid Dr. Borelli, who is already pestering him with constant unwanted advice on every little thing. The plan backfires, though, since Borelli volunteers to go along with him.
At the aid station, not to mention on the way there, Borelli continues to pester Hawkeye with advice. The two butt heads on everything, including how to treat the patient. Pierce lays down the law and informs the consultant that he is in charge. It’s his patient.
Borelli, though, notices that Captain Kramer has some nerve damage to his face. This makes him a candidate for the nerve graft technique that Borelli came to present in the first place. He advises Hawkeye to leave the facial wound open:
Dr. Borelli: Did you notice his face?
Hawkeye: Yeah, bad laceration.
Dr. Borelli: And the left side of it wasn’t moving when I put him under. Probably has nerve damage.
Hawkeye: Forget it. Even if he needs a graft, he’s in no condition to stay under the anesthetic an extra two or three hours.
Dr. Borelli: I agree. But if he does need a graft, I’d like to take a crack at it back at the 4077. I recommend leaving the wound open. Just pack it.
Hawkeye: No, we’ll suture it. If the paralysis persists, we can open it again.
Dr. Borelli: Leave it open. He’ll be fine. Besides, there’s less danger of infection.
Hawkeye absolutely disagrees. They continue to operate, and the bombs begin exploding around the aid station, making both doctors nervous. Corporal Jarvis, who’s already fed up with their bickering, tells them to keep going. An explosion shakes the tent, and all three men are thrown to the ground. Jarvis is unhurt, but both Hawkeye and Borelli are injured. Hawkeye’s left wrist is injured, while Borelli’s right arm is hurt. This forces them to work together on the operation, using only Hawkeye’s right hand and Borrelli’s left. Thus, “Dr. Right” and “Dr. Left” successfully complete the surgery and learn to get along in the process.
Borelli asks Hawkeye if he still wants to close up the facial laceration:
Dr. Borelli: You still want to close up that facial laceration?
Hawkeye: How sure are you about leaving it open?
Dr. Borelli: Positive. If-If he does need a nerve graft, that’s the best way to go.
Hawkeye: All right. Then that’s what we’ll do.
Borelli: Whatever you say, Dr. Right.
Hawkeye: No, whatever you say, Dr. Left.
While this is not a case of debridement and delayed primary closure, it is an example of how medical criticisms of MASH often miss the mark by focusing on the wrong details. Here, we have a MASH doctor disagreeing with the wisdom of leaving a wound open for a later surgery, as if this is a foreign concept when, in fact, one as experienced as Hawkeye would have done this many times, as it was, in fact, preferred in such cases. A visiting consultant should not have been needed to explain that there is less danger of infection.
However, the entire premise is perhaps inaccurate as Drs. Pierce and Borelli would not have been likely to perform a full operation on Dr. Kramer, complete with final closure, as was depicted in the episode. Instead, the patient would have been stabilized and then immediately transported to the MASH. On the other hand, once a surgery was completed, there would be no reason not to transfer the patient straight to a larger field hospital. The reality behind the evacuation and transfer of patients is the most inaccurate medical detail on the show.
Meanwhile, the aid station still had no doctor, so Hawkeye would have needed to stay until a replacement arrived. Another question is, if Kramer was not stable enough to be transported, how was he stable enough to wait for the arrival of the surgeons? Best not to nitpick!
Lend a Hand is the second time that Alan Alda acted with his father, Robert Alda, in MASH. Here, we get a bonus: Corporal Jarvis was played by Alan Alda’s brother, Antony Alda!
