Certain types of debridement can be painful. Wounds can be prepped with topical or injectable anesthetics to reduce or eliminate the pain. Wounds sometimes require a serial approach to debridement, meaning dead tissue will be removed week after week and as needed. How often a wound undergoes debridement is dependent upon the amount of devitalized tissue in the wound, size of the wound, and cause of the wound.
In general, wounds can undergo debridement once a week. If you are unsure if your wound has necrotic tissue that needs to be debrided, contact a wound care specialist to schedule an appointment for an evaluation. In certain circumstances debridement may not be beneficial for the patient and in some instances could be detrimental: for example patients with peripheral arterial disease who develop distal gangrene Figure 1.
With dry gangrene, it is better to leave these wounds without any dressings rather than promoting debridement. This is because in the debridement process levels of moisture at the wound bed will increase leading to a greater risk of infection. Combined with arterial disease this would expose the patient to an increased risk of amputation.
In patients with peripheral arterial disease, debridement should only be initiated by the specialist vascular team, ideally after adequate revascularisation has been established. When to debride? The type of tissue found in the wound bed often provides a clear indication as to whether debridement is required but other factors such as bio-burden, wound edges and condition of peri wound skin can also influence the decision of whether debridement is required.
There are relatively few wounds where it is not safe to debride, as long as the correct method of debridement is chosen. The presence of non-viable tissue will delay wound healing as it hinders the formation of granulation tissue but it can also be a cause of bacterial growth increasing the risk of infection.
Debridement may also assist in wound assessment or pressure ulcer categorisation as removing non-viable tissue, slough and excess exudate will help to visualise the wound bed depth and condition more accurately. Debridement options Various factors influence the choice of debridement methods such as wound type, anatomical location, extent of devitalised tissue, pain, patient environment, resources and patient choice.
Debridement may only need to be performed once, but more commonly episodic or continual debridement may be required over a number of weeks. Therefore there needs to be consideration of the risk that the devitalised tissue presents to the patient to help determine the speed of debridement required.
Wound debridement remains a generalist nursing skill and all practitioners involved in wound care need to be aware of the wide range of debridement options. However, certain methods of debridement, such as sharp debridement, can only be performed by clinicians with appropriate knowledge and clinical skills.
Nevertheless, it is important that the most appropriate debridement method selected is based on it providing the best outcomes for the patient and not limited to the skills of the practitioner.
For many wounds more than one method of debridement may be required and currently there is no robust evidence favouring one method over another. Methods of debridement commonly used in the UK include:. Autolytic Autolytic debridement is the most commonly used method of debridement. Autolytic debridement is useful where there are small volumes or superficial slough, however it can be a slow process often taking weeks to achieve a clean wound bed. This slow rate of debridement may raise the potential for infection and maceration of the peri-wound skin 9.
Larval Larval therapy maggots is a form of biological debridement Figure 5. The larvae of the greenbottle fly has been bred in sterile conditions for medical use for a number of years, and the maggots debride by secreting a proteolytic enzyme which liquefies the dead tissue.
Once this tissue is dissolved the maggots then ingest the fluid neutralising any bacteria in their gut. They do not, as commonly believed, bite or chew the dead tissue. Other benefits of larvae therapy have been published including increased irrigation of the wound bed by the movement of the larvae stimulating exudate production 10 and increased granulation growth rates through the changes in PH level on the wound bed increasing oxygenation and a number of growth factors.
Larval therapy offers a fast selective method of debridement but is not suitable for all wounds. The effectiveness solely relies on the survival of the larvae, so there needs to be consideration of whether they may be squashed, for instance if used on a heel of an active patient or if exudate levels are very high that they may drown.
Not all patients accept the idea of maggots on their wound and detailed conversations with the patient must take place prior to their application to ensure the patient is fully informed and consents to treatment.
Debridement can be accomplished either surgically or through alternate methods such as use of special dressings and gels. The technique alters the environment of the chronic wound and promotes healing. Hyperkeratotic, infected, and nonviable tissue is surgically removed using a scalpel or special scissors. This "sharp debridement" allows the surgeon to clearly visualize the foot ulcer. During the procedure:. Autolytic Debridement - This uses the body's own enzymes and moisture to re-hydrate, soften, and liquefy non-viable tissue.
Autolytic debridement is selective so that only necrotic tissue is liquefied. Chapter 8. Medline University. The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc. Wound bed maintenance is the process taken by the bedside clinician or nurse to create or preserve the wound environment at optimal conditions and thus encourage the chronic wound to move to a state of closure or healing.
Critical thinking skills require a trained eye focused on the We have all heard the saying: a dry cell is a dead cell… we know that a moist wound bed is most conducive to healing. If a wound is too dry, we add moisture… and if a wound is too wet, we try to absorb the drainage.
There must be a As a wound care nurse practitioner, when I see granulation tissue start to form on a wound, I do a little happy dance. Granulation tissue is a sign that the wound is on its way past an often-stubborn inflammatory phase of healing and View the discussion thread. Important Notice: The contents of the website such as text, graphics, images, and other materials contained on the website "Content" are for informational purposes only.
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. The content is not intended to substitute manufacturer instructions.
Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or product usage. Refer to the Legal Notice for express terms of use. Skip to main content. Submitted by WoundSource Pra Blog Category:. Wound Bed Preparation.
0コメント