Technology and product reviews T E C H N O L O G Y U P D A T E :


The important role of debridement in wound bed preparation


Although the literature highlights the importance of wound debridement, there is often confusion around selecting the most appropriate method[1]


. In addition, concerns around competence


and scope of practice are an important factor when discussing this technique[2]


debridement in the clinical practice setting.


INTRODUCTION Since the concept of wound bed preparation arose[3]


, striving to achieve a wound


environment that is conducive to healing has become increasingly important[4]


.


Debridement plays a crucial role in this concept, eliminating non-viable tissue from the wound bed, which would act as a significant barrier to wound repair if not removed[5]


.


Although the term wound bed preparation is relatively modern[3]


, its underlying theoretical principles are not new[6] — after all,


Hippocrates, the 'father of Western medicine', was the first to stress that the body heals itself[7]


. However, healthcare providers are


charged with enabling the process of healing to occur unhindered[8]


. This, Hippocrates


argued, takes place only through accurate assessment and diagnosis[7]


. acronym[9]


In modern terms, practitioners use the TIME to accurately assess the wound,


identify the presence of devitalised tissue and plan appropriate interventions[9,10]


:


T = tissue (non-viable or deficient) I = infection/inflammation M = moisture (imbalance) E = edge (non-advancing or undermined). Wound bed preparation provides a


structured approach to the management of non-healing wounds, and the removal of barriers through the principles of TIME can encourage endogenous wound healing


THE CRUCIAL ROLE OF DEBRIDEMENT The process of wound repair involves a finely-


balanced sequence of events, each stage controlled by stimulators and inhibitors that are naturally produced by the body[11]


for wound healing to progress, cells need to migrate into the wound bed and multiply[12] Devitalised tissue is a barrier to cell


. The devitalised


tissue prolongs the inflammatory response, enhancing the excess production of pro- inflammatory cytokines[14]


. Cytokines, which are signalling proteins


produced by cells, are a large family of diverse regulators that play an important role in wound healing[15]


References . They carry signals


between cells, thereby stimulating the influx of other cells required for tissue repair. Over- or under-production of cytokines will have a detrimental effect on wound healing. This, in turn, locks the wound into a state of chronicity, thereby impeding the wound healing process[13]


. Understanding the adverse impact devitalised


tissue has on wound healing emphasises the importance of debridement in wound management[10]


. For wounds to heal successfully,


the wound bed needs to be adequately prepared and debridement is central to this process[16]


.


Current methods of debridement Debridement may be conducted in a variety of different ways and choosing the most appropriate method depends on: n The patient: for example, any presenting condition that may be a contraindication for use of a specific method of debridement. In addition, the patient's


1. Cuddigan JE, Ayello EA. Clinical decision making for debriding chronic wounds. World Council of Enterostomal Therapists Journal 2004; 24: 8.


2. Dowsett C. The role of the nurse in wound bed preparation. Nurs Stand 2002; 16: 69.


3. Schultz GS, Sibbald RG, Falanga V, Ayello EA, et al. Wound bed preparation: a systematic approach to wound management. Wound Rep Regen 2003; 11: S1–28


4. EWMA. EWMA position document: wound bed preparation in practice. 2004; MEP, London, UK.


5. Dowsett C, Claxton K. Reviewing the evidence for wound bed preparation. J Wound Care 2006; 15: 439–42.


6. Hampton S. Some simple solutions to wound debridement. Nurs Res Care 2011; 13: 378.


. The author aims to clarify the fundamentals of successful


Author: Zena Moore


. In order Useful links .


migration and provides an ideal environment for bacterial proliferation[13]


Wound bed preparation revisited Wound bed preparation in practice


www.woundsinternational.com


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