J O U R N A L O F WO U N D C A R E Vo l 2 2 . N o 1 . E W M A D o c u M E N t 2 0 1 3
considered. Therefore, the consent of the patient
should be obtained whenever possible.
Costeffectiveness
There is little evidence available on these methods
with regard to clinical efficacy and economic
effectiveness in comparison to other methods
of debridement. However, the resources needed
to perform these procedures may provide an
approximate indication of the level of cost.
Sharp debridement is relatively cheap with regard
to staff resources and materials. It can be performed
by a single staff member. Materials required
include a scalpel or scissors, forceps, curette and
sterile materials, such as drapes, gauzes, gloves,
and containers for tissue biopsy and swabs. In
addition, antiseptic medications for pre-procedure
site preparation, wound cleansing following the
procedure and proper dressings are required. Special
procedure packs, containing drapes, gauzes and
disposable instruments, are available on the market.
In comparison, costs related to surgical
debridement are high. They include, but are
not limited to, the cost of the surgical team
(surgeon, nurse, anaesthesiologist, anaesthesia
nurse etc), labour, and cost of the operating
theatre, anaesthesia and materials for surgery.
Surgical debridement also requires a set of surgical
instruments, usually including various sizes of
scissors, scalpels, curettes, saws, drills, osteotomes,
forceps, needle holders and others. The need to
stop bleeding often occurs and an electrocautery
machine is, therefore, an important part of the
equipment. Surgery also requires sterile materials
(surgical coats and gloves, drapes, gauzes),
antiseptic medications and dressings.
conclusions
Surgical and sharp debridement are rapid
methods of dead tissue removal from the wound,
including devitalised, necrotic tissue or fibrin
from the wound and peri-wound skin. These
methods can be used for all types of wounds.
Although clinically effective, both sharp and
surgical methods should be used with some
precautions, due to the risk of over-excision
and wound damage, which might delay later
wound healing. Alternative methods to sharp
and surgical debridement should be considered,
if non-viable tissue demarcation does not extend
deeper than the deep-dermal layer, or the
wound bed is covered by fibrin or slough. These
situations usually require more gentle methods of
debridement, to avoid excess wound-bed damage
during the procedure.
‘
Despitethemajorroleof
surgicaldebridementin
currentwoundmanagement,
thereislittleevidenceavailable
todocumentthebenefits.
’
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