Download - Wound Debridement & Adjunctive Wound Care2
Wound Debridement & Wound Debridement & Adjunctive Wound CareAdjunctive Wound Care
Wound Care Management2-4th October 2012HRPZ II KOTA BHARUDR MOHAMMAD IZANI BIN
IBRAHIM
What is DEBRIDEMENT?What is DEBRIDEMENT?Removal of dead, damaged, dying
or unhealthy tissue from the wound bed to promote healing
3 main types
1.Active2.Autolytic(moisture donation)3.Autolytic(moisture absorption)4.Enzymatic
Active DebridementActive DebridementSharp debridement
Biological debridement
Chemical debridement
Mechanical debridement
Surgical DebridementSurgical DebridementDebridement using surgical intruments
such as scalpels and forceps either in operating theatre or in the ward ( procedure room or bedside)
Involves removal of all non viable and compromised tissue until a healthy bleeding wound bed is achieved.
This causes an inflammatory response from the wound which stimulates healing.
Reasons for DebridementReasons for DebridementRemoves necrotic and infected tissue and
callus
Decreases bacterial burden, allows deep tissue culture
Turns chronic wound to acute and resets stage towards normal wound healing
Allows application of bioengineered products
Assessment of WoundAssessment of Wound1.Nature of the necrotic/ischemic tissue
and the best debridement procedure to follow
2.The risk of spreading infection and use of antibiotic
3. Underlying medical condition
4. Extent of ischemia in the wound tissues
5. Location of the wound on the body
When Consultation When Consultation Needed?Needed?
Vascular insufficiency
Gangrenous digit/wound
Unidentifiable structure(eg:neurovasc structures)
Coagulopathy
When Consultation When Consultation Needed?(2)Needed?(2)
Stable heel ulcer-firmly adherent, lack of inflammation, lack of drainage, eschar that does not feel soft or boggy)
Fungating/malignant like wounds
Necrotic tissue near neurovascular structure
Wounds of hand and face
Indications Indications
Extensive devitalized tissue
Signs advancing soft tissue infections or sepsis
Presence of thick adherent eschar
Callous formation
Principals of Surgical Principals of Surgical DebridementDebridementDebride in stages to minimize damage
to healthy tissue
Stay within a fascial plane during debridement to avoid spreading bacteria into the lower layers
Small bleeders stopped by applying pressure, larger ones require diathermy or ligations
Pain control
Tissue Viability Tissue Viability DifferentiationDifferentiation
Necrotic Viable
Fat DullGraybrown to black
ShinyYellow
Fascia DullGraybrown to black
GlisteningWhite
Muscle Dark redbrown to gray
Dull redContraction when pinched
All Tissue InsensateAvascular- no bleedingFoul odor
Vascular – bleedingLittle or no odor
Biological DebridementBiological DebridementMaggot Debridement Therapy (MDT)Lucilia Cuprina- sterile maggotsMOA-remove slough-stimulate wound healing-disinfect the woundCI-Wound needing urgent debridement-Poor vascularity, abscess-entomophobia
Chemical DebridementChemical DebridementHydrogen peroxide and sodium
hypochlorite (EUSOL)
Has bactericidal effects
Unfortunately they have toxic effects on healthy tissue and fibroblast
Also painful
Mechanical DebridementMechanical DebridementNecrotic tissue can be physically
pulled from the wound bed
Methods availablea)Wet to dry gauzeb)Scrubbing wound with scalpelc)Whirlpool (hydrotherapy/pulse lavage)d)Wound irrigatione)Ultrasonic debridement
High Power Hydrostatic High Power Hydrostatic DebriderDebrider
Jets of warmed solution are used to loosen the bonds between the adherent necrotic material and the viable tissue.
Effective, but expensive and has problem about equipment cleansing and cross infection
Ultrasonic DebridementUltrasonic Debridementutilizes low frequency pulsed
ultrasound directed to the wound surface via an ultrasound probe.
Wound irrigation fluid (0.9% Normal Saline) is directed through an opening in the probe’s tip as a coupling medium, coolant, wound lavage or flush.
Autolytic (moisture Autolytic (moisture donation)donation)
Hydrocolloids, hydrogels, honey and silver sulphadiazine donate moisture to the wound and enhance the process of debridement
However care must be taken to prevent surrounding tissue becoming macerated.
Autolytic (moisture Autolytic (moisture absorption)absorption)
Alginates, cadexomer iodine and Hydrofiber facilitate autolytic debridement by absorbing moisture(exudate) from the wound while ensuring that necrotic tissue does not dry out.
Enzymatic DebridementEnzymatic Debridement
Uses topically applied enzymatic agents to stimulate the breakdown of non-viable tissue
Faster debridement process compared to Autolytic
Eg: Clostridiopeptidase A, honey and fibrinolysin with DNAse
When NOT TO DEBRIDE?When NOT TO DEBRIDE?Necrotic tissue = BAD =To DebrideBut there are exceptionsIn cases with inadequate blood supply,
tissue regeneration can be poor or absent
Debridement will expose underlying structures to dessicate and bacterial ingress
In certain cases the necrotic tissue is left in situ
Adjunctive TreatmentsAdjunctive Treatments
Honey dressing
Hyperbaric Oxygen Therapy
Negative Pressure Wound Therapy(NPWT)- VAC( Vacuum Assisted Closure)
Honey DressingHoney DressingHoney is mainly used to promote
granulation and epithelization of a wound
Types- raw honey Supermarket honeyTherapeutic honey- Manuka,
Tualang etc
Honey Dressing (2)Honey Dressing (2)
Honey has antibacterial effects which are attributed to its high osmolarity, low pH, hydrogen peroxide content, and presence of other uncharacterized compounds.
Honey Dressing(3)Honey Dressing(3)promote enzymatic debridementdeodorize malodorous woundsstimulate growth of wound tissues to
accelerate healingstimulate anti-inflammatory activity that
reduces pain, edema and exudates.minimizes hypertrophic scar promote moist wound healingcontains low level hydrogen peroxide
which stimulates fibroblast proliferation and angiogenesis
HONEY DRESSING
Hyperbaric Oxygen TherapyHyperbaric Oxygen TherapyIntermittently breathing pure(100%)
oxygen at greater(2-3 times) atmospheric pressure
Used for decompression disease, necrotizing fascitis and carbon monoxide poisoning
MOA in Wound MOA in Wound ManagementManagementAngiogenesis in ischemic tissues
Bacteriostatic and bactericidal
Inhibit C. perfringes alpha toxin synthesis
Leukocyte oxidative killing
Negative Pressure Wound Negative Pressure Wound Therapy (NPWT)/VAC- Vacuum Therapy (NPWT)/VAC- Vacuum Assisted ClosureAssisted Closure
Indicated for huge, clean, exudative wound while waiting for definitive wound closure.
Also for fixation of skin grafts.
How VAC Works?How VAC Works?Provides a closed and moist wound
healing environment
Removes excess fluids that can inhibit wound healing
Helps remove interstitial fluids
Promotes granulation and decreases wound volume
VAC Contraindicated in?VAC Contraindicated in?Necrotic wound bed or aschar
Untreated osteomyelitis
Clotting disorders
Neoplastic tissue in the wound
Contraindicated in
TAKE HOME MESSAGETAKE HOME MESSAGESharp debridement- fastest and
gold standard for wound with active infection/ sepsis
Recognize wound which can/don’t need debridement
Adjuvant therapy mainly for clean wound- promote granulation/epithelization
THANK YOUTHANK YOU