Practice development Ten top tips for wound debridement


softens devitalised tissue and encourages autolysis. It should be used with caution on arterial and diabetic foot wounds.


5


Mechanical debridement: this is a wet-to-dry technique where the dressing sticks to the


top layer of the tissue, pulling it away when removed. However, mechanical debridement is not selective about the tissue it removes and can be very painful, removing healthy tissue at the same time as necrotic tissue. Mechanical debridement is very cheap, but can be time-consuming due to the frequency of dressing changes and can also be very traumatic for the patient. A debriding pad (Debrisoft®


; Activa


Healthcare) has recently been introduced, which should be moistened and gently applied to the wound bed in a rotational movement. The fibres (monofilaments) or hoops of the pad retain the dead tissue and bacteria within pad, thus removing the debris.


6


Larval therapy: the larvae of the green bottle fly (Lucilia sericata) secrete an enzyme,


which breaks down necrotic tissue into a liquid. This is then ingested by the larvae. This particular larvae do not touch healthy tissue and the technique can, therefore, be seen as a selective micro-debridement[3]


. The larvae are


available 'free range' or bagged and must be applied to a moist wound bed to keep them alive. For optimum results, the outer dressing should be moistened daily. The treatment can be used consecutively without a break,


although it is important to make sure that patients are comfortable with the procedure as some can find it distasteful. Free range larva can be used for digit


removal if a bone is diseased and the patient is considered too high a risk for theatre. Larvae also have the capacity to lower bacterial colonisation within the wound. Larvae need to be double-bagged and burnt


for disposal. 7


Sharp debridement: this is usually undertaken by a specialist or surgeon with training


in debridement. It can be performed in a treatment room or at the bedside. It is essential that the clinician knows which structures are to be removed to avoid complications, such as excessive bleeding or ligament damage. If excess bleeding does occur, it is useful to have an alginate dressing at hand to place upon the wound to aid haemostasis. If a limb is involved, it should be elevated. This process should only be performed where resources are available in case of complications[4]


. It is not suitable as a


home-based treatment. The results of sharp debridement are fast,


but may need to be repeated over time, for example, in the treatment of diabetic feet where off-loading of pressure points on planter surfaces is not adequate. Topical treatments will be ineffective against the repeated trauma of patients continuing to walk on wounds as they do not feel any pain. Essentially this process relies on the


practitioner's understanding of the patient's


Page Points


1. Mechanical debridement is a wet-to-dry technique where the dressing sticks to the top layer of the tissue, pulling it away when removed


2. The larvae of the green bottle fly (Lucilia sericata) secrete an enzyme, which breaks down necrotic tissue into a liquid, which is then ingested by the larvae


Figure 1. Hydrosurgical surgery being performed on a mixed aetiology ulcer.


3. Sharp debridement is usually undertaken by a specialist or surgeon with training in debridement


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Practice development


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