Debridement

By Cheryl Carver, LPN, WCC, CWCA, DAPWCA, FACCWS

May is Mental Health Awareness Month and with the staggering statistics of one in four adults living with mental illness, I immediately was motivated to write a personal blog. I previously shared my son’s experience here in 2020, in “Wound Management Challenges in Prison Populations,” and discussed the importance of establishing a quality of wound care. I started thinking about the high number of incarcerated people with mental health issues, and it prompted me to conduct a bit more research. Given my son's dual diagnosis of schizophrenia and post-traumatic stress disorder (PTSD), I recall having a conversation with him during this time about debridement methods because advanced wound care would become extremely complicated. I immediately started educating him on possible dressings and debridement methods that could be used on his wound. This gave him an idea of what to expect and allowed him to decline certain treatments if he so preferred.

For the wound healing process to be successful, it must pass through four stages: hemostasis, inflammation, proliferation, and remodeling or maturing. Wound healing requires inflammation, but it can be detrimental if it is persistent or encouraged by other factors, such as infection. It is during this phase that wound healing is most likely to stall.

Effective wound management often requires attending to multiple aspects of the wound itself, including properly preparing the wound bed and managing moisture and exudate, among other facets of wound care. Tissue viability is another crucial aspect of wound management. Unfortunately, many types of wounds, including acute and chronic wounds, contain devitalized tissue.

Devitalized tissue inhibits healing in multiple ways. It can serve as a source of nutrients for bacteria, especially if the tissue is necrotic. Devitalized tissue also acts as a physical barrier for re-epithelialization, thereby preventing topical compounds from penetrating the wound bed when required. Further, this tissue can prevent angiogenesis, granulation tissue formation, epidermal resurfacing, and standard extracellular matrix (ECM) formation. It can also cover the wound and render it difficult for clinicians to assess the extent and severity of the wound adequately.

Patient-centered care is a philosophy that stresses communication, collaboration, and health promotion while also respecting patients' expectations, autonomy, and values. It is at the heart of global efforts to enhance the delivery of safe, high-quality, and cost-effective health care. Patients who are involved in their own treatment are more motivated and capable of caring for their own health and well-being, according to most research, because they understand the impact the treatment will have on their health.

By the WoundSource Editors

Debridement is the process of removing nonviable tissue and foreign objects (such as glass or shrapnel) from a wound bed to help the wound heal. Decaying tissue can trap bacteria and lead to a harmful infection such as gangrene, which is the death of body tissue resulting from a lack of appropriate blood flow or in response to a severe bacterial infection. Debridement is thus critical to effective wound management.

Arteriography: Also called angiography, this technique is the medical imaging of blood vessels to look for aneurysm and stenosis.

Hemosiderin staining: Hemosiderin staining results in a red, ruddy appearance on the lower leg and ankle. This appearance is caused when red blood cells are broken down and not removed adequately as a result of venous insufficiency or another medical condition.

Phlebectomy: A minimally invasive procedure (usually outpatient) to remove varicose veins located near the surface of the skin.

Anoxia: A condition marked by the absence of oxygen reaching the tissues. It differs from hypoxia, in which there is a decrease in the oxygen levels to tissue.

Biocide tolerance: Demonstrating a tolerance to substances that destroy living things, such as bacteria. The initial stage in the life of biofilm can become biocide tolerant within 12 hours.

Calcium alginate: A water-insoluble, gelatinous substance that is highly absorbent. Dressings with calcium alginate can help to maintain a moist healing environment.

Sharp debridement is by far the fastest way to remove non-viable tissue from a wound bed. This modality must be performed by a licensed skilled practitioner using sharp instruments or tools to remove unhealthy tissue. It is reimbursed by most payers when documentation and medical necessity support its use. There are times when sharp debridement is contraindicated, however. This blog reviews the contraindications and alternatives to sharp debridement.

Approximately 2 million people in the United States are living with limb loss, and this figure is expected to double by 2050. Lower-limb amputation accounts for the vast majority of all amputations, and diabetes—specifically, diabetic foot ulcers (DFUs)—is the leading cause of nontraumatic lower-limb amputations in the US. Although already high, the rate of amputation is increasing.

Complex and hard-to-heal chronic wounds impact millions of people globally. In the United States, care for these types of wounds exceeds $25 billion annually. Wound healing naturally progresses through the overlapping phases of hemostasis, inflammation, proliferation, and remodeling. With chronic and complex wounds, the natural biological healing process stalls in the inflammatory phase, thereby preventing both the proliferative phase and further advancement toward wound closure.