It is important to remove all forms of foreign matter and devitalized, dead, or contaminated tissue as part of the process of preparing beds of wounds. Clinicians use the term wound debridement to refer to the process by which necrotic and other materials are removed from wounds. Slough or necrotic materials are the terms used for all kinds of non-viable tissues found in wounds. Necrotic materials have a brownish or blacking color whereas slough is fibrinous yellow in color.
There is often an accumulation of necrotic tissue in chronic wounds. This tissue is comprised of exudate, non-viable tissue, necrotic material, and high bacterial levels. The tendency of necrotic tissue to accumulate is higher in chronic wounds. The cause of chronic wounds is venous insufficiency and diabetes among other underlying and uncorrected pathogenic abnormalities. Resolving these systemic issues in full is normally impossible. As such, it becomes important to prepare the bed of the wound in order to facilitate closure of the wounds.
Debridement is important due to a number of reasons. First, devitalized tissue need to be removed to allow the clinician to be able to assess how deep wounds are and to know what condition surrounding tissues are in. The second reason is that necrotic tissues often mask symptoms of local infections in the wound. Finally, when necrotic tissue is present, it serves as a physical barrier to the healing process and also significantly supports growth of bacteria.
Bacterial colonies contained in necrotic tissues create damaging proteases. Proteases negatively affect reepithelialization process and production of granulation tissues. As such, by debriding wounds the likelihood of contamination and destruction of tissue is reduced greatly. It is the elimination of cell debris that contribute to reduced tissue destruction.
There are four main methods of debriding wounds, that is, mechanical, autolytic, surgical or sharp, and enzymatic. Which method is chosen for debriding is made based on several factors. Some of the factors include the type, position, and size of wounds, pain management, time available for the process, moisture levels, and the healthcare setting. The overall condition of the patient is also considered a lot when choosing the methods to be used. Sometimes multiple methods may be employed at once.
Surgical or sharp debriding procedure is the fastest method to use in removing debris and necrotic tissues from wound beds. This approach is most suitable when the clinician cannot tell the depth of wounds due to presence of excess necrotic tissue. It is also the best option for removing infected materials and bones.
There are several advantages associated with the use of the surgical approach. First, it results in the least level of damage to tissue surrounding the wounds. Secondly, the procedure may lead to minor bleeding which releases cytokines and other inflammatory mediators which help in the process of repairing wounds. The patient has to be assessed first for suitability of this method to them before it can be used.
There are many shortcomings associated with this approach too. First, it can only be used on individuals with uncompromised immune systems and no bleeding disorder of any kind. Secondly, it results in transient bacteremia and patients may feel a lot of pain at times. Finally, tendons and nerves get damaged sometimes.
There is often an accumulation of necrotic tissue in chronic wounds. This tissue is comprised of exudate, non-viable tissue, necrotic material, and high bacterial levels. The tendency of necrotic tissue to accumulate is higher in chronic wounds. The cause of chronic wounds is venous insufficiency and diabetes among other underlying and uncorrected pathogenic abnormalities. Resolving these systemic issues in full is normally impossible. As such, it becomes important to prepare the bed of the wound in order to facilitate closure of the wounds.
Debridement is important due to a number of reasons. First, devitalized tissue need to be removed to allow the clinician to be able to assess how deep wounds are and to know what condition surrounding tissues are in. The second reason is that necrotic tissues often mask symptoms of local infections in the wound. Finally, when necrotic tissue is present, it serves as a physical barrier to the healing process and also significantly supports growth of bacteria.
Bacterial colonies contained in necrotic tissues create damaging proteases. Proteases negatively affect reepithelialization process and production of granulation tissues. As such, by debriding wounds the likelihood of contamination and destruction of tissue is reduced greatly. It is the elimination of cell debris that contribute to reduced tissue destruction.
There are four main methods of debriding wounds, that is, mechanical, autolytic, surgical or sharp, and enzymatic. Which method is chosen for debriding is made based on several factors. Some of the factors include the type, position, and size of wounds, pain management, time available for the process, moisture levels, and the healthcare setting. The overall condition of the patient is also considered a lot when choosing the methods to be used. Sometimes multiple methods may be employed at once.
Surgical or sharp debriding procedure is the fastest method to use in removing debris and necrotic tissues from wound beds. This approach is most suitable when the clinician cannot tell the depth of wounds due to presence of excess necrotic tissue. It is also the best option for removing infected materials and bones.
There are several advantages associated with the use of the surgical approach. First, it results in the least level of damage to tissue surrounding the wounds. Secondly, the procedure may lead to minor bleeding which releases cytokines and other inflammatory mediators which help in the process of repairing wounds. The patient has to be assessed first for suitability of this method to them before it can be used.
There are many shortcomings associated with this approach too. First, it can only be used on individuals with uncompromised immune systems and no bleeding disorder of any kind. Secondly, it results in transient bacteremia and patients may feel a lot of pain at times. Finally, tendons and nerves get damaged sometimes.
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