Wound Debridement Kairy

8/3/2019 Wound Debridement Kairy

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WOUND DEBRIDEMENT

DR. KHAIRI HASSAN


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Definition Removal of foreign material and dead

or contaminated tissue from and

around a traumatic or infected lesionin order to expose healthy tissue andoptimize healing.


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PHASES Initial Phase:

Removing burden of necrotic tissue

(Surgery; Maggots, etc.) Maintenance Phase

Keep the wound free of necrotic

tissue (Dressing, enzymes, etc.)


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DEBRIDEMENTWhat?

Why?When?

Who?


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WHAT?

Debris, slough or necrotic tissues:

Devitalized, necrotic or contaminated

tissue consisting of fibrinous material,nucleoproteins, collagen and elastin

This material interferes with thenormal healing process, because itprovides a medium for bacterialgrowth and it acts as physical barrierto repair.


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METHODS (HOW

?) Surgical and sharp debridement

Mechanical

- Hydrotherapy- Wet-to-dry dressing

Autolytic

Enzymatic

Biological such as Maggot therapy

Chemical


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SELECTING THE

APPROPRIATE METHOD Type of wound (depth, tissue

involved)

Type of necrosis (dry, wet, infected) Type of patient

Skill of clinician

Resources Care setting


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ADVANTAGES OF DEBRIDEMENT Efficient debridement is essential in

treating all wounds

Allow healthy granulation tissue toform

Reduces wound contamination andfurther tissue destruction

Reduces dead spaces that harbourbacterial growth


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SURGICAL/SHARP DEBRIDEMENT Advantages:

- highly selective

- rapid result

- simple

- universal usable

Disadvantages:

- invasive, damaging

- skilled personnel- risk of anaesthesia

- maybe expensive


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MAGGOT THERAPY

EXPECTED MODE OF ACTION

Eating necrotic tissueDebridementIngested bacteria are killed in thegut

Kills bacteria

Production of Ammoniap o pH pinhibits bacterial growth

Environmental

Secretion of chemical with anti-microbial activities

Antibiotic effect

Combined effect of earlier effects.Direct stimulatory effect

o Wound healing


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INDICATION All types of problem wounds; surgical

or other types of debridement are

difficult, risky or not available Other conditions e.g. osteomyelitis,

burns, abscesses, necrotising fascitis

Preparation for grafting


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MAGGOT THERAPYContraindications:

1. Absolute

Fistula, wound, connected to bodycavity, rapid advancing tissuenecrosis

2. RelativeExposed vessel, bleeding tendency,difficult dissolving tissue


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ADVANTAGES/DISADVANTAGES

Disadvantages

-Theethicalaspect

-Requiressomeskill

-Maybeexpensive

-Cancausepain

-Notavailableinallplaces

Advantages

-Effective

-Selective

-Simple

-Rapid

-Universalusable

-Killsbacteria

-Mayo healing


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AUTOLYTIC DEBRIDEMENT Definition:

The process by which the wound bed

utilizes phagocytic cells andproteolytic enzymes to removedevitalized tissue.

This process to can be promoted andenhanced by maintaining a moistwound environment


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AUTOLYTIC DEBRIDEMENT Use of moisture-retentive dressing

Slower process than other methods

Progress should be observed within72-96 hours

Wound will increase in length, width,depth

Attention to peri-wound maceration Collection of wound exudate and

accompanying odour as indicative ofan infection


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ENZYMATIC DEBRIDEMENT Definition:

The use of topically applied chemical

agents to stimulate the breakdown ofnecrotic tissue.

Common topical agents:

- collagenase- fibrinogen/deoxyribonuclease

- papain/urea


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MODE OF ACTION Directly digesting the components of

slough (fibrin, bacteria, leukocytes,

cell debris, serous exudate and DNA) Dissolving the collagen anchors that

secure the avascular tissue to theunderlying wound bed


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ENZYMATIC DEBRIDEMENTAdvantages/Disadvantages Uses topical applications/exogenous

enzymes to the wound surface

Useful in removing eschar from largewounds

Excess exudate may be produced by thisagents

Ointments may be used to protect peri-wound intact skin

Enzymes and reimbursement implications


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CONCLUSIONRemoval of foreign material and dead or

contaminated tissue from a traumatic

or infected lesion is essential fortreatment and outcome of problemwounds.

The effectiveness of wound debridement

depends on the knowledge, skill andability of the individual practitionerand the cooperation of the patient.


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THANK YOU.

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Wound Debridement Kairy