Posts Tagged ‘autolytic debridement’

Debridement Basics. How Many Methods Are There?

Monday, December 1st, 2014

beamsDebridement is the removal of necrotic, dead tissue from the wound bed. It also plays a vital role in the tissue management concept of Wound Bed Preparation.  Wound Bed Preparation is the comprehensive approach we use to get our chronic wounds to heal. There are two main categories of debridement:  selective and non- selective debridement.  Selective debridement are methods where only necrotic, non-viable tissue is removed from the wound bed. Non-selective debridement methods remove both necrotic tissue and viable living tissue.

There are 5 major debridement methods. They are known by the acronym BEAMS.  The Selective methods include:  Biological, Enzymatic and Autolytic debridement methods.  The non-selective methods are: Mechanical and Sharp debridement methods.

Biological debridement is also known as maggot debridement using sterile medical maggots to remove necrotic tissue. These sterile maggots debride necrotic tissue by liquefying and digesting it, they also kill and ingest bacteria while stimulating wound healing.

Enzymatic debridement is the use of collagenase ointment (Santyl) once daily to the wound bed. The ointment works from the bottom up to loosen the collagen that holds the necrotic material to the wound bed. It is a faster method than autolytic debridement, but slower than sharp debridement.

Autolytic Debridement is the slowest type of debridement. It uses the body’s own enzymes to assist in breaking down the necrotic tissue. This is achieved by using products that maintain a moist wound environment. This type of debridement is not appropriate for large amounts of necrotic tissue or infected wounds.

Mechanical debridement is a method that uses an external force to separate the necrotic tissue from the wound bed. This may be painful and removes non-viable as well as viable tissue.  Methods include wet to dry dressings, scrubbing, whirlpool and irrigation. Contraindications for mechanical debridement would be epithelializing and granulating wounds.

The fastest method of debridement is Sharp debridement. There are 2 types, Sharp surgical (done by a surgeon, physician or podiatrist) or sharp conservative (done at bedside by a trained clinician). It involves the use of scalpels, scissors, curettes or forceps.  Sharp surgical is a major procedure that sacrifices some viable tissue where sharp conservative is a minor procedure done at the bedside that removes non-viable tissue.

The debridement method used will be chosen on a variety of factors including the wound characteristics, amount of necrotic tissue in wound, efficiency and selectivity of the debridement method itself, pain management for your patient, the cost of the procedure, exudate levels of the wound, presence of or risk of infection, the patients care setting, and the patients overall medical condition all need to be taken into account.

It is also important to remember not every patient with necrotic tissue will always be a candidate for debridement. Be sure that you understand indications and contraindications for each debridement method when you are selecting the method for your patient.

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Wound Care Dressings: Hydrogel Dressings

Tuesday, July 7th, 2009

In our day to day practices of wound care we deal with many types of wound care dressings. Today we will focus on Hydrogel Dressings.

NDM-409020-si

Description A three-dimensional network of hydrophilic polymers containing varying percentages of water, that bind great volumes of liquid due to the presence of hydrophilic residues. Hydrophilic properties enable them to absorb excess exudate while producing a moist wound environment. Formulations may vary, either glycerin based or contain 90% water in a gel base.  They are available in a sheets, gel, sprays, impregnated gauze or packing strips.

Function They provide for moist wound healing, autolytic debridement and are able to absorb a minimal amount of fluid. Hydrogels add moisture to the wound bed, are non-adherent and assist with pain relief when applied cold.

Hydrogel

When to Use:

  • Partial and full thickness wounds that are dry or moist
  • Granulating wounds

  • Abrasions, partial thickness burns
  • Skin reactions to radiation
  • Necrotic wound and wounds covered with eschar

Contraindications

  • Full thickness burns
  • Moderate to highly draining wounds

Advantages

  • Cooling and soothing
  • May be used on infected wounds.
  • Provides hydration of eschar and nonviable tissue to promote debridement.
  • Facilitates wound repair and epithelialization.

Disadvantages

  • Gel sheets: Must be cut to exact size of wound to prevent maceration of surrounding tissue.
  • Requires a secondary dressing cover.
  • Dehydrate if not covered.

Reminders

  • Care must be taken to avoid macerating surrounding skin.
  • Utilize for light to moderate absorption.
  • Clean wound between dressing changes with normal saline or per manufacturers recommendations.
  • Dressing changes every 1-4 days as needed.
  • For Radiation burns: Dressing may be stored in refrigerator and applied to wound cold, to provide soothing and pain reduction

As health care workers and wound care professionals we encounter patients with wounds. It is pertinent that we remain aware of the types of dressings available to us and their indications as well as contraindications for use. If you would like more information on how to use these dressings, consider becoming Wound Care Certified. Check out WCEI’s Course Info here