Debridement tools

The dermis contains blood and lymph vessels, nerves, and other structures, such as hair follicles and sweat glands. In general, the indication for debridement is the removal of devitalized tissue such as necrotic tissue, slough, bioburden, biofilm, and apoptotic cells.

Debridement is recognized as a major component of wound management to prepare the wound bed for reepithelialization. Devitalized tissue, in general, and necrotic tissue, in particular, serve as the source of nutrients for bacteria.

Devitalized tissue also acts as a physical barrier for reepithelialization, preventing applied topical compounds to make direct contact with the wound bed to provide their beneficial properties. Necrotic tissue also prevents angiogenesis, granulation tissue formation, epidermal resurfacing, and normal extracellular matrix ECM formation. Finally, the presence of necrotic tissue may prevent the clinician from making an accurate assessment of the extent and severity of the wound, even masking possible underlying infections.

Schiffman et al. Contraindication of wound debridement, in general, may be applied to dry and intact eschars with no clinical evidence of underlying infection such as with an unstageable pressure ulcer with an intact eschar at the sacrum or buttock or heel.

Several types of the debridements can achieve removal of devitalized tissue. These include surgical debridement, biological debridement, enzymatic debridements, and autolytic debridement. This is the most conservative type of debridement.

This type of debridement is a natural process by which endogenous phagocytic cells and proteolytic enzymes break down necrotic tissue. It is a highly selective process whereby only necrotic tissue will be affected in the debridement.

It is indicated for noninfected wounds. It may also be used as adjunctive therapy in infected wounds. It can be used with other debridement techniques such as mechanical debridement in the case of infected wounds. It requires a moist environment and a functional immune system.

The use of moisture retentive dressings can enhance it. This type of debridement induces softening of the necrotic tissue and eventual separation from the wound bed. The effectiveness of this type of debridement is mandated by the amount of devitalized tissue to be removed as well as the actual wound size.

Autolytic debridement will take a few days. If a significant decrease in necrotic tissue is not seen in 1 or 2 days, a different method of debridement should be considered. Biological debridement, also known as larval therapy, uses sterile larvae of the Lucilia sericata species of the green bottle fly. It is an effective mode of debridement, particularly appropriate in large wounds where a painless removal of necrotic tissue is needed.

Other modes of action contributing to the overall result of larval therapy are:. Maggots can be applied to the wound bed. They can be enclosed in a biological bag or are free range. Studies have shown that free-range maggots can debride a wound at least twice as fast as bag-pain maggots. Comparison studies of either free-range maggots treatment versus bio bag contained maggots versus hydrogel autolytic debridement shows days to complete debridement to be 14 versus 28 versus 72 days respectively.

Contraindications to biological debridement are an abdominal wound contiguous with the intraperitoneal cavity, pyoderma gangrenosum in patients with immunosuppression therapy, and wounds in proximity to areas afflicted by septic arthritis. This is a selective method for debridement of necrotic tissue using an exogenous proteolytic enzyme, collagenase, to debride Clostridium bacteria.

Collagenase digests the collagen in the necrotic tissue allowing it to detach. Enzymatic debridement is a slow method of the debridement as from hair to mechanical and sharp debridement.

Enzymatic debridement is not recommended for an advanced process, or in patients with known sensitivity to the product's ingredients. A relative contraindication of enzymatic debridement is its use in heavily infected wounds. Furthermore, collagenase should not be used in conjunction with silver-based products or with Dakin solution.

This is a type of debridement where devitalized tissue slough, necrotic, or eschar in the presence of underlying infection is removed using sharp instruments such as a scalpel, Metzenbaum, curettes, among others.

This can be done bedside, in the office or wound care center, or in the operating room depending on the adequacy of anesthesia and the ability to control perioperative complications like bleeding. Designed by a surgeon, EZ Debride is a simple to use, sharp debridement instrument. EZ Debride can allow clinicians with little or no prior debriding experience, to confidently and precisely debride like an expert; removing non-viable tissue and bioburden rapidly, easily and safely.

Discovering the EZ Debride wound debridement instrument has made influential changes in my practice. Performed aseptically, a skilled practitioner can precisely and selectively excise necrotic tissue to minimise the risk of infection. Autolytic debridement is facilitated by products that maintain a moist wound environment, promoting the break down of non-viable tissue by enzymes present in wound exudate.

I am recommending this course to my colleagues. It was an excellent learning experience, as well as fun. By the end of the session I felt good about what I could do. I am looking forward to working with my preceptor in the clinical setting.

Thank you for helping me to be able to give my patients high quality, competent wound care. Advanced Wound Debridement. Course Overview. PURPOSE: The overall objective of this program is to provide comprehensive education to licensed health care professionals regarding wound bed preparation using different types of debridement, with an emphasis on conservative sharp debridement.

Course Content. Live hands-on practicum with skills performance check off. All texts, debridement instruments and supplies are included. Students receive documentation of competency in performing conservative sharp upon completion of this course. Recognize anatomical structures and types of tissue commonly seen in sharp debridement.

Identify the different types of debridement and understand the indications and contraindications of each. Recognize new technologies and products used in the debridement process. Identify tools used in the sharp debridement process. Discuss the appropriate terminology and documentation used in sharp debridement to optimize reimbursement. Demonstrate sharp debridement techniques. Discuss legal implications and policy and procedures related to debridement.

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