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Wound Care Management 2-4th October 2012 HRPZ II KOTA BHARU DR MOHAMMAD IZANI BIN IBRAHIM
What is DEBRIDEMENT?
Removal of dead, damaged, dying or unhealthy tissue from the wound bed to promote healing 3 main types
1. 2. 3. 4.
Active Debridement
Mechanical debridement
Surgical Debridement
Debridement 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.
Removes 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 Wound
1.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
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
Debride 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
Fascia
Muscle
All Tissue
Biological Debridement
Maggot Debridement Therapy (MDT) Lucilia Cuprina- sterile maggots MOA -remove slough -stimulate wound healing -disinfect the wound CI -Wound needing urgent debridement -Poor vascularity, abscess -entomophobia
Chemical Debridement
Hydrogen peroxide and sodium hypochlorite (EUSOL) Has bactericidal effects Unfortunately they have toxic effects on healthy tissue and fibroblast Also painful
Mechanical Debridement
Methods available a)Wet to dry gauze b)Scrubbing wound with scalpel c)Whirlpool (hydrotherapy/pulse lavage) d)Wound irrigation e)Ultrasonic debridement
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 Debridement
utilizes 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 probes tip as a coupling medium, coolant, wound lavage or flush.
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.
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 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
Adjunctive Treatments
Honey dressing
Hyperbaric Oxygen Therapy Negative Pressure Wound Therapy(NPWT)- VAC( Vacuum Assisted Closure)
Honey Dressing
Types raw honey Supermarket honey Therapeutic honey- Manuka, Tualang etc
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)
promote enzymatic debridement deodorize malodorous wounds stimulate growth of wound tissues to accelerate healing stimulate anti-inflammatory activity that reduces pain, edema and exudates. minimizes hypertrophic scar promote moist wound healing contains low level hydrogen peroxide which stimulates fibroblast proliferation and angiogenesis
HONEY DRESSING
Intermittently breathing pure(100%) oxygen at greater(2-3 times) atmospheric pressure Used for decompression disease, necrotizing fascitis and carbon monoxide poisoning
Angiogenesis in ischemic tissues Bacteriostatic and bactericidal Inhibit C. perfringes alpha toxin synthesis Leukocyte oxidative killing
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
Contraindicated in
Sharp debridement- fastest and gold standard for wound with active infection/ sepsis
THANK YOU