Debridement

Temple University School of Podiatric Medicine's picture

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.

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WoundSource Practice Accelerator's picture

Wound debridement is a critical strategy in treating hard-to-heal wounds. It is a process that expedites healing by removing necrotic tissue, non-viable tissue, and foreign material. It can also be used to manage biofilm to prevent infection. Debriding a wound exposes the healthy underlying tissue to promote healing. There are several methods of debridement. Determining the best option will depend on the health care setting as well as the characteristics of the wound being treated.

WoundSource Editors's picture

In a recent survey, we asked our WoundSource Editorial Advisory Board members what outdated wound care practices they continue to see in the field. Depending on what health care setting clinicians work in, there are specific guidelines, policies, and procedures that may impact standard of care. Our board members come from a variety of backgrounds, so their answers varied based on their areas of expertise, but there were a few practices that they could all agree should be left in the past. Do you still use any of these?

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Ron Sherman's picture

By Ronald A. Sherman, MD

Challenges are nothing new for those of us who work in health care. Every day, we triumph over difficult situations. Yet, the current coronavirus outbreak has complicated even the simplest of procedures and has brought us additional challenges.

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WoundSource Editors's picture
Silver Nitrate Sticks

By the WoundSource Editors

Silver nitrate is a natural, inorganic chemical compound with antimicrobial properties that has been used in medical applications since the 13th century. It is used as a cauterizing agent and is available as a solution or an applicator stick. The applicator sticks, known as silver nitrate sticks or caustic pencils, contain silver nitrate and potassium nitrate. There are certain brands of silver nitrate sticks that can be bent or shaped to increase ease of access within a target area. The silver nitrate stick is activated by contact with moisture. When applied to wounds, silver nitrate sticks deliver free silver ions to the tissue that form an eschar as they bind to tissue and obstruct vessels.

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Achieving Closure

By the WoundSource Editors

Wound healing is a highly complex chain of events that allows the skin to repair and regenerate to provide protective functions, such as temperature modulation, and moisture regulation, as well as sensation reception and transmission.

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Patient Considerations

By the WoundSource Editors

Wound debridement is often necessary to address the underlying causes of chronic wounds, remove non-viable tissue, manage biofilm, and ultimately promote and expedite the healing process. There are multiple methods of debridement, including surgical/sharp, autolytic, mechanical, biological, enzymatic, ultrasonic, hydrosurgical, or synergistic (combination of debridement methods). Selecting the most appropriate methods of debridement is crucial in treating chronic and acute wounds successfully and optimizing the healing environment.

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WoundSource Practice Accelerator's picture
Debridement

By the WoundSource Editors

Wound debridement is a crucial strategy for addressing some of the underlying causes of wound chronicity. The wound healing process can be impacted by chronic disease, vascular insufficiency, diabetes, neurological defects, nutritional deficiency, advanced age, and local factors such as pressure, infection, and edema. Debridement can expedite healing when used to remove necrotic tissue, other non-viable tissue, and foreign material. It can also be a tool to manage biofilm. Debridement exposes the viable underlying tissue, which promotes healing. There are several methods of debridement; determining the best option depends on the health care setting as well as the characteristics of the wound being treated.

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TIMERS

By the WoundSource Editors

Wound bed preparation is a well-established concept, and for many years the TIME framework – consisting of addressing Tissue Management, Inflammation and Infection, Moisture Balance, and Edge or Epithelial Advancement – was the standard tool used by clinicians to manage patients’ wounds throughout the wound care cycle.

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WoundSource Practice Accelerator's picture

By the WoundSource Editors

Conservative sharp debridement: Conservative sharp debridement is done outside the operating room, and although it removes necrotic tissue and debris, it is not as aggressive a procedure as surgical sharp debridement.

Eschar: Eschar is dead tissue and is found only in full- thickness wounds. It may be tan, brown, or black.

Fibroblasts: Fibroblasts have several roles in wound healing, including breaking down fibrin clots, creating new extracellular matrix and collagen structures, and contracting the wound.

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