indications and contraindications for sharp debridement

INDICATIONS AND CONTRAINDICATIONS

FOR SHARP DEBRIDEMENT

Indications for sharp debridement: When do we debride?

• Presence of devitalized tissue

• Presence of gross infection

• Amount of necrotic tissue so great that other methods would be too slow

• Adjunct to other methods of debridement

““IF IT’S DEAD, IT’S DEAD.”IF IT’S DEAD, IT’S DEAD.”

- Glenn Silverstein, DPM September 13, 2012- Glenn Silverstein, DPM September 13, 2012

Contraindications for Sharp Debridement

• Patient is on an anticoagulant: especially parenteral

• Patient has a disorder such as hemophilia or other coagulopathy

• There is a reason the patient cannot stay still which could cause harm to the debrider or debridee!

• No consent

Contraindications for Sharp Debridement

• Poor vascular perfusion

• Inadequate anesthesia

• Cannot properly identify anatomic structures

• Good healthy granulation tissue

Wound Assessment

• Know the patient! i.e. Medical history, current meds., history of the wound

• Know the anatomy of the area to be debrided

• Identify the wound type, tissue type

Know the patient: Medical History

Diabetes, peripheral vascular disease, collagen vascular disease, cancer, nutritional status, cigarette usage, alcohol or illegal drug use, family support, etc.

Know the patient: Medications

• Insulin (diabetes well controlled?), coumadin, heparin, Lovenox, Plavix, steroids

Know the patient: Wound History

• How did the wound occur?

• How long has it been present?

• What treatments have been used?

• Is it improving, worsening or staying the same?

Know the anatomy!

Know the wound type

Arterial, venous, diabetic (neuropathic), burn, insect bite, collagen vascular, pressure

Identify the tissue type

• Eschar/Necrotic

• Erythema/Edema/Venous stasis dermatitis

• Slough/Fibrin

• Induration/Blistering/abscess (fluctuant)

• Keratosis/Maceration/Dead Fat

• Perfusion Vs. No perfusion

• Color/Granulation tissue/Hypergranulation

• Purulence/Sinus Tract/Tunneling

• Woody/Fibrotic/Dermatosclerosis

• Hematoma

Eschar

Necrosis

Erythema

Edema

Slough

Fibrin

Induration

Blistering/abscess

Keratosis

Maceration

Dead fat/fascia

Perfusion

No perfusion

Color

Granulation Tissue

Hypergranulation

Purulence

Sinus Tract/Tunneling

Woody/Fibrotic “lipodermatosclerosis”

HematomaHematoma

Heart shaped wound