Wound Debridement PT 632

What are 6 reasons should you debride a wound?

1. DECREASE BIOBURDEN**

2. increased efficacy of topicals

3. DECREASED INFLAMMATORY PHASE**

4. decrease tissue barriers to healing

5. decrease wound odor

6. allows wound borders to be visualized

What is the difference between a scab and eschar?

scabs are a normal part of the healing process, eschar is a sign of deeper tissue necrosis and needs clinical attention

What are the 6 steps in the wound management process?

1. remove dressing

2. cleanse the wound

3. examine the wound

4. DEBRIDE if needed

5. cleanse wound again if needed

6. apply new dressing

What are the 4 different types SELECTIVE of debridement?

1. sharp

2. autolytic

3. enzymatic (chemical)

4. larval

What are the 2 different types of NONSELECTIVE debridement?

1. mechanical like scrubbing

2. hydrotherapy/PLWS

What are things to consider with sharp debridement?

- its painful (need for analgesic)

- risk of hemorrhage

- requires training

- is pt on anticoags?

- lighting

- clean/sterile consideration

What are the contraindications for sharp debridement?

- pt on anticoags/has bleeding abnormalities

- immunocompromised pts d/t poor healing

- underlying dialysis, fistula, or arterial graft

- mm, tendon, lig, capsule, bone, nerve are exposed

- infection

- STABLE ESCHAR ON HEEL

What are the pros and cons of sharp debridement?

PROS: highly selective and can be done relatively fast

CONS: pain, limited by pts on anticoags, need time and specialized skill

What are the considerations for autolytic debridement?

- minor/mod debridement

- minimal risk of infection

- selective and safe, but is slow

- painless and smoothing with dressing

- risk of maceration, but absorptive dressing can dehydrate wound bed

What are contraindications for autolytic debridement?

- exposed tendon/bone

- friable skin

- deep wounds

- immunocompromised patients

- severe neutropenia

The process of autolytic debridement is always an effect of what 4 things?

a HEALTHY, MOIST, WARM, and PROTECTED wound

What are the pros and cons of autolytic bridement?

PROS: not pain, don't have to do much

CONS: can't use with infection, slow, only for minor/mod tissue

What are the considerations for enzymatic debridement?

- a collagenase ointment is typically used

can be used on infected wounds

- not used with heavy metal salts (silver and mercury)

- may need to cross-hatch eschar

- selective

What are the contraindications of enzymatic debridement?

- clean wounds

- allergy: stop if rash/itching/swelling occurs like especially is trouble breathing

What are the pros and cons of enzymatic debridement?

PROS: can be used with infected wounds

CONS: need to cross hatch eschar to get deeper

What are the considerations for larval debridement?

- psychological distress for pts

- potential for increased pain in ischemic wounds

- time consuming (days)

- VERY selective

- can be used for various wound types

- idea is that the maggots just leave the wound when done??

What are the contraindications for larval debridement?

- allergic** (to adhesives, larvae, eggs, soy beans)

- pts with bleeding abnormalities

- deep and tunneled wounds**

What are the considerations for mechanical debridement?

- larger wounds

- non-selective

- painful

- dressing fibers can stick to wound and cause foreign body reaction

- bleeding

- increase circulation

- possible maceration

What is the contraindication for mechanical debridement?

- clean wounds

- diabetic neuropathy

What product can be used for moisture and be effective against bacteria but also helps wound healing?

acetic acid 1% concentration