Use of a Novel Mechanical Method* to Remove Devitalized Tissue and Hyperkeratosis

Background:
Debridement remains a foundation of wound bed preparation. While weekly sharp debridement is a gold standard for wound management, numerous barriers prevent this from occurring in real-world settings. These include the lack of access to a skilled sharp debridement practitioner, scope of practice licensing issues regarding the performance of sharp debridement, safety issues regarding the setting in which this is performed, or specific patient-related clinical issues such as pain management. Given that biofilm can reform within 24 hours of debridement, synergistic methods to enhance the removal of devitalized tissue and, presumably biofilm, may enhance outcomes.

Methods:
Patients having at least one wound were evaluated to determine effect of a conformable polyester-fiber pad* (CPFP) on mechanical removal of devitalized tissue and presumed biofilm. The CPFP was moistened with 40 cc of water (4), normal saline (4) or hypochlorous solution (2) after dressing removal. Choice of solution was left to the evaluator based on patient’s clinical setting and medical history. The wound was cleansed in a circular motion using downward pressure for two to five minutes based on results and patient tolerance. Pain was evaluated before, during and after using a visual analog scale.

Results:
Ten patients with 18 wounds were treated. A 67% decrease in devitalized tissue with presumed biofilm was observed. No increased pain levels during or after CPFP application were reported. One patient, due to her pain and anxiety level, performed her own CFPF application and reported this as a
preferred method of wound cleansing. Of the 8 patients with periwound hyperkeratosis, there was a reduction (3) or elimination (4) in periwound hyperkeratosis.

Conclusions:
The use of a CPFP for mechanical removal of devitalized tissue and disruption of biofilm is a viable adjunctive management strategy that can overcome known barriers to sharp debridement in a variety of settings. Further study is warranted.