Technology and product reviews


preferences for a specific mode of treatment


Page Points


1. Debridement plays a crucial role in eliminating non-viable tissue from the wound bed, aiding wound repair


2. When selecting the most appropriate


debridement technique, the competence of the practitioner is central to the decision- making process


n The wound and its aetiology n The environment in which care is being provided, eg the facilities, equipment and resources


n The competence of the practitioner n The availability of particular treatment options[14]


.


The debridement methods most frequently seen in current practice are outlined below.


Surgical/sharp debridement Excision of devitalised tissue using a scalpel or scissors[17]


. This method requires skill and References


7. Garrison FH. History of Medicine. 1966; W.B. Saunders Company, Philadelphia.


8. Ayello EA, Cuddigan JE. Conquer chronic wounds with wound bed preparation. Nurs Pract 2004; 29: 8.


9. Schultz GS, Barillo DJ, Mozingo DW, Chin GA. Wound bed preparation and a brief history of TIME. Int Wound J 2004; 1, 19–32.


10. Fletcher J. Wound bed preparation and the TIME principles. Nurs Stand 2005; 20: 57.


11. Hopkinson I. Molecular


components of the extracellular matrix. J Wound Care 1992; 1: 52–54.


12. Iocono JA, Erlich HP, Gottrup F, Leaper DJ. The biology of healing. In: Leaper DJ, Harding KG (eds). Wounds Biology and Management.


1998; Oxford Medical Publications, Oxford: 10–22.


13. Young T. Debridement — is it time to revisit clinical practice? Br J Nurs 2011; 20(suppl): 24–28.


14. Young T. Reviewing best practice in wound debridement. Prac Nurs 2011; 22: 488–92.


15. Slavin J. The role of cytokines in wound healing. J Pathology Bacteriol 1996; 178, 5-10


16. Kirshen C, Woo K, Ayello EA, Sibbald RG. Debridement: a vital component of wound bed


preparation. Adv Skin Wound Care 2006; 19: 506–19.


17.Granick M, Boykin J, Gamelli R, Schultz G, Tenenhaus M. Toward a common language: surgical wound bed preparation and


debridement.Wound Repair Regen 2006; 14(suppl): 1–10.


competence and an awareness of the potential for excess bleeding in certain patient groups[18]


Training in surgical/sharp debridement is required in order to practise safely.


Mechanical debridement This involves the use of wet to dry dressings. The dressing adheres to the wound bed as it dries, thus removing the top layer of tissue as the dressing is pulled away[19]


. This method


is not selective, in that healing tissue may be removed alongside dead tissue[19]


. Furthermore, it is a painful procedure


and, as such, is likely to cause the patient distress[19]


. It is worth considering that


patients rate comfort above healing in the selection of wound treatments[20]


. Thus, this


method of debridement may be unacceptable to some patients.


Autolytic debridement Autolysis is the process of removing dead tissue from the wound using the body's production of enzymes. These enzymes degrade the dead tissue in the presence of moisture[21]


Innovative developments There are a number of new products focused on wound debridement[29]


. For example,


the UK's National Institute for Health and Clinical Excellence (NICE) recently reviewed a therapy known as MIST[30]


, which delivers . It requires moisture, thus topical


treatments that create a moist wound-dressing interface are needed. Although this method is selective, in that only devitalised tissue is removed, it is slow. However, it is considered to be relatively safe[22]


. Thus, when speed


is needed, this is not the most appropriate method to choose.


Enzymatic debridement This involves specific enzymes being applied to the wound bed. The enzymes, such as collagenase, are similar to those that occur naturally during the wound healing process. Their primary function is to degrade the damaged extracellular matrix[23]


. In order for 19 20 Wounds International Vol 3 | Issue 2 | ©Wounds International 2012


low-energy, low-intensity ultrasound to the wound bed through a continuous saline mist. The ultrasonic energy delivered to the wound is thought to stimulate wound healing, by removing devitalised tissue and bacteria, thereby enabling the wound to progress through the healing process. NICE suggests that this therapy may be a promising adjunct to current debridement methods, potentially enhancing the healing of complex, non-healing chronic wounds, when compared with standard methods of wound management[30] Vowden and Vowden[31]


. recently reviewed


another addition to the debridement armoury — a pad comprising polyester fibres that loosen devitalised tissue, while absorbing exudate and binding debris to the dressing. This method is preferable to mechanical debridement because healthy tissue is not removed with the


.


Larval therapy This method involves the use of sterile maggots from the larvae of the green bottle fly[25]


wound healing to progress, damaged tissue needs to be removed. If this does not occur, the dead tissue acts as a barrier to cell-to-cell migration. If cells cannot communicate with each other, the production of new tissue, to replace the tissue that has been lost, will be impaired. A systematic review by Ramundo and Gray[24] suggests that enzymatic debridement is a useful alternative to sharp debridement, which carries the risk of bleeding. However, more often, enzymatic debridement may be used in combination with sharp technique, especially when a series of debridement treatments is required[24]


.


. The larvae only target devitalised tissue, which they dissolve due to the presence of proteolytic enzymes in their saliva. The dissolved tissue is then used by the maggots as a source of nutrients[26]


. One survey identified


that patients were not resistant to the use of larvae as a treatment for leg ulcers[27]


. Larvae


may increase the rate of debridement of sloughy or necrotic leg ulcers compared with autolytic debridement, however, the method can be more painful[28]


.


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