Debridement

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.

Tissue viability is crucial in managing all types of wounds, including surgical wounds, traumatic wounds, pressure injuries, lower-extremity ulcers, and skin tears. Accurate assessment and wound diagnosis are important in treating symptoms and understanding the underlying pathophysiology of the wound.

Collagenase: An enzymes that breaks the peptide bonds in collagen. Collagenases aid in destroying extracellular structures. Collagenase is one of the most frequently used enzymatic debridement agents.

Enzymatic debridement: A topical treatment that uses naturally occurring proteolytic enzymes or proteinases, which break down and remove devitalized tissue by digesting and dissolving this tissue in the wound bed.

Keratotic tissue: Keratotic tissue is the development of horny growths (keratomas). These growths can appear at the edges of wounds and hinder healing. They are removed by debridement to promote healing.

By Temple University School of Podiatric Medicine Journal Review Club

The treatment of wounds has advanced significantly over the years and has involved a variety of therapy options, but the percentage of wounds that heal after 12 weeks remains at a mere 40%. One idea to improve wound healing is to improve diagnostic imaging of wounds, similar to the technological advances seen in many other specialties. Wound healing is costly, especially given that many wounds are hard to heal or there is difficulty in identifying the best course of treatment for the wound. If the current wound healing treatments show minimal improvement in four weeks and there are still thousands of bacteria-forming units on the wound, the clinician should re-evaluate the therapies being utilized and consider a change in treatment.

Chronic and non-healing wounds are those that do not progress through the healing process in a timely or predicted manner. They are a global problem and are becoming harder to treat. Medicare estimates that over 8 million Americans have chronic wounds that cost the national health care system between $18.1 and $96.8 billion dollars annually.

The use of wet-to-dry dressings has been the standard treatment for many wounds for decades. However, this technique is frowned on because it has various disadvantages. In this process, a saline-moistened dressing is applied to the wound bed, left to dry, and removed, generally within four to six hours.

By Temple University School of Podiatric Medicine Journal Review Club

Chronic wounds require an increased amount of oxygen to help with cellular function and growth. They often manifest with biofilm, slough, and necrotic tissue, all of which deprive cells of the oxygen they need to perform vital functions. Various forms of debridement are commonly employed to rid wounds of pathological tissues that negatively affect cellular communication and growth. Sharp surgical debridement is most frequently performed by physicians. Continuous diffusion of oxygen (CDO) involves the use of humidified, purified air at 3mL/hour in conjunction with moist wound therapy (MWT) dressing. A previous paper by Niederauer et al. published in 2018 in the Journal of Wound Care, described using CDO for healing DFUs. This study showed that CDO improved the healing rate of DFUs in terms of time, chronicity, and weight-bearing ability when compared to a placebo. Additionally, the previous paper described wound size, chronicity, and adverse events.