Debridement

By Becky Naughton, RN, MSN, FNP-C, WCC

When I was in my APRN program, a phrase that I heard from an instructor has stuck with me throughout my practice: "When it comes to diagnosing, if you hear hooves, think horses, not zebras." Essentially, think of the obvious or likely reason first before jumping to a more obscure diagnosis. In the large majority of cases, the more common ailment is likely the cause. But what happens if the symptoms just don't quite add up?

By the WoundSource Editors

Necrotic wounds are characterized by devitalized, or dead, tissue. Necrosis may be caused by malignancy, infection, trauma, ischemia, inflammation, or exposure to toxins. It may also be caused by improper care of an existing wound site. Devitalized tissue has no blood supply, and its presence prevents wound healing. It is necessary for necrotic tissue to be removed to allow wound healing to occur.

By Emily Greenstein, APRN, CNP, CWON, FACCWS

The New Year is finally here, the beginning of a new decade. And we all know that with the calendar change comes the urge to get rid of any and all bad habits. Time to start over, wipe the slate clean, and transform into something amazing. Except, in reality it never seems to happen that way. We may start out well and then fall off the wagon and back into old habits.

Temple University School of Podiatric Medicine Journal Review Club

Delayed healing in diabetic foot ulcers (DFUs) is the result of the polymicrobial structures of DFUs and the buildup of biofilms. Wound debridement is an essential part of wound bed preparation (WBP) that helps to remove bacteria and allow the body to continue the healing process. Although sharp debridement is the most common technique used for DFUs, it has many limitations, including contraindications in patients with poor vascular status, the need for an operating room, and the requirement for specific surgeon skills. There is also the potential for extensive damage to the wound bed with exposed bone because of obstruction of the view from biofilm formation. The use of an ultrasound-assisted wound (UAW) debridement device aims to disrupt the formation of biofilms and stimulate wound granulation, thus allowing for the wound to have a healthy environment in which to heal. This study evaluated the clinical and microbiological impact of using UAW debridement devices in individuals with neuroischemic DFUs.

Article Title: Graduating Student Nurses' and Student Podiatrists' Wound Care Competence: A Cross-Sectional Study
Authors: Kielo E, Salminen L, Suhonen R, Puukka P, Stolt M
Journal: J Wound Care. 2019;28(3):136-145
Reviewed by: Stephanie Golding, class of 2020, Temple University School of Podiatric Medicine

By the WoundSource Editors

Wound bed preparation is a well-established concept, and the TIME framework is the standard tool used to assist clinicians with the management of patients’ wounds throughout the care cycle. Recent clinical and technological breakthroughs are enhancing our understanding of this care cycle. An overview of the wound bed preparation care cycle and the TIME framework is provided here.

By James McGuire, DPM, PT, LPed, FAPWHc

In my recent WoundSource webinar, I discussed the topic of debridement strategies and chronic wounds. The webinar is still available for viewing on WoundSource.com. Wound debridement is the foundation for healing in chronic wounds. Excessive debridement is a detriment to healing, whereas proper removal of accumulated non-viable tissue or foreign material from the wound bed maintains a healthy progressive healing trajectory and avoids wound chronicity.

By Ronald A. Sherman, MD

The year 2019 began with a shadow over the field of biosurgery and a dark cloud over American health care: BioMonde, currently the largest producer of medicinal maggots in the world, just closed its American laboratory. Most famous for its dressing containing medicinal maggots within a net bag (BioBag™), BioMonde has been very profitable in Europe for years, where it operates two busy maggot-producing laboratories (in Wales and Germany). In 2014, with $5 million of dedicated investor funding, BioMonde opened a laboratory in Florida to serve the American market. Despite the popularity of their flagship product, BioMonde's US laboratory never turned a profit. Simply stated, sales were not high enough... but why?

By the WoundSource Editors

The wound healing cascade is a complex process that follows a strict sequence of molecular events. The complex series of events depend on one another and must take place in a timely and orderly fashion within the body’s natural host processes. The phases of acute wound healing, in order, are hemostasis, inflammatory, proliferative, and maturation. If the cascade of events is interrupted, the acute wound status then develops into a non-healing or chronic status. Wound stalling occurs in the inflammatory and proliferative stages of healing. In chronic wounds, there appears to be an overproduction of matrix molecules resulting from underlying cellular dysfunction and dysregulation. Non-viable or devitalized tissue lengthens the inflammatory phase of healing and increases risk of infection.

By the WoundSource Editors

Wound chronicity is a major concern, and removing barriers with each stage of healing is paramount. Debridement may occur naturally by the body’s own ability to slough off dead tissue; however, often this tissue needs to be removed medically. The goal of wound debridement is to provide consistent wound bed preparation along with good healing outcomes. Removing non-viable tissue and foreign material is the first goal of debridement. Non-viable tissue not only inhibits the development of healthy new tissue but also increases the risk of infection. Non-viable tissue includes slough and eschar, which create the perfect recipe for bacterial growth and infection. Viable tissue is granulation and epithelial tissue, which is beneficial to normal healing. Wounds that present devitalized tissue and/or biofilm warrant one or more of the debridement methods to promote healing. Since 2006, debridement has been found to be advantageous in managing complex wounds.