Practice development How to...Innovations Useful links


Importance of wound debridement in management of diabetic foot ulcers


The autolytic debridement of venous leg ulcers


diagnosis, thorough wound assessment and the practitioner's clinical capabilities and knowledge of the process.


8


Surgical debridement: this process is usually undertaken within the confines of theatre,


where large amounts of necrosis or septic tissue need to be urgently removed, for example, in cases of necrotising fasciitis. The process is not selective — healthy and necrotic tissue are often removed together as there is a need for clear margins and large wounds are frequently exposed using this method. Theatre time is expensive and the patient will need follow up treatments to achieve full healing. This process can be very painful and expensive, but is often necessary in the case of bacterial sepsis. Following this treatment, topical negative


pressure is often used to speed up wound healing, control exudate and prevent hospital- acquired infections, thereby allowing patients to go home quicker and reduce hospital bed occupancy.


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Hydrosurgical debridement: this is a simple and effective process, which uses pressurised


water or saline as a cutting/cleaning tool [Fig 1]. The pressure is controlled via a handpiece and should only be used by a trained practitioner. The hand-held units can be expensive to buy or rent while the feeder heads have to be bought separately. Disposal can also be costly. The process is effective, however, protective


clothing and goggles should be worn when undertaking this process to protect from 'splash-back' and cross-contamination.


Practice development How to...Ten top tips for debridement


The technique is quick and can be used in most settings.


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Ultrasound: there are two ultrasound techniques currently used and each has


a very different mode of application. The first type works through 'agitating' the wound bed directly. It uses an ultrasound probe, which is applied to the wound via a single-use head, incorporating a cleaning system that removes debris and bacteria. The second type uses an atomised saline solution or 'mist', where the gas-filled bubbles explode at the wound bed, lifting necrotic tissue and bacterial cells. Again, this process can be expensive,


however, the results are instant and effective. Protective clothing should also be used as mentioned above.


CONCLUSION In today's changing healthcare environment it is essential that clinicians work within their own capabilities and are aware of the financial burden being placed upon services, with more expensive treatments being scrutinised for effectiveness. Wound care debridement techniques are


constantly developing and can, if used correctly, lower the use of antimicrobial products as well as the cost of dressing budgets.


AUTHOR DETAILS Kathleen Leak is a Sister in Wound Care, Doncaster and Bassetlaw Foundation Trust, UK.


To access free


basic wound care education visit Wound Essentials...


online at: www.wounds-uk.com/wound-essentials 23 Wounds International Vol 3 | Issue 1 | ©Wounds International 2012


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