Jwc ewma final indd

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  

S 4 1

Fig 8.Choiceoftechniques:Benefitsanddisadvantagesrelatedtovarioustechniques

MECHANICAL 

DEBRIDEMENT

SHARP

DEBRIDEMENT

?

LARVE

THERAPY

?

AUTOLYTIC 

OR ENZYMATIC

DEBRIDEMENT

?

JET LAVAGE 

OR 

ULTRASOUND

?

SURGICAL 

DEBRIDEMENT

NO

NO

NO

NO

NO

YES

YES

YES

YES

YES

Leasttime

consuming

BENEFItS

Veryfastmethod

Nospecialexpertiseneeded(easytouse)

Modernmechanicaldebridementproducts

areclaimedtocauselittletonopain

Nodamagetohealthytissue(selectivedebridement).

DISADVANtAGES

Traditionalwet-to-drydebridementmayresult

inincreasedriskofinfectionandriskofdamage

tohealthytissueandpain

Notefficientincasesofthick,tenaciousslough

andhardnecrosis(demandpriorsoftening).

Fastmethod

Costandresources:fewresourcesneededwith

regardtostaffandmaterials

Efficientinwoundswithasolidlayerofnecrotictissue

Suitableforexudativewoundsand,insomecases,

infectedwounds.

Riskofinfection,ifsterileconditionsarenotensured.

Reducepain,bacteriaandmalodour

Costandresources:fewresourcesneeded

Separatenecrotictissuefromlivingtissue.

Maybepainful

Contraindicatedforsomepartsofthebody,for

patientswithdecreasedperfusion,woundswith

exposedbloodvesselsconnectingtodeepvital

organs,andincancerwounds.

Easytouse

Costandresources:maybecostsavingdueto

fewerdressingchanges(decreaseinstaffhours)

Littleornopain

Nodamagetohealthytissue(selectivedebridement)

Autolytic:mayprovideexudationmanagement

(ifdressinghasabsorptiveproperties).

Riskofallergicreactionstoingredientsofthe

dressingsandriskofinflammation

Somedressingsarenotsuitableforhighlyexudative

wounds(enzymatic,hydrogels,occlusivedressings)

Enzymatic:Needamoistenvironmenttowork

effectively;mayleadtoexcessiveproductionof

exudate(notsuitableforhighlyexudativewounds)

Autolytic:Thedebridementprocessistimeconsuming;

contraindicatedforinfectedwounds.

Jet lavage:Flexiblemodesofaction(invarioustypes

ofproducts)suitablefordifferentwoundconditions

Ultrasound:Caninterferewithmanydifferent

structuresandhasarangeofeffects,varyingfrom

destructiontodislocationandphysicalmodification.

Equipmentisnotgenerallyavailableinthevarious

typesoftreatmentsettings

Costeffectiveness:costofequipmentishigh

Forhydrosurgeryespecially,skilledstaff,treatment

roomandanaesthesiaareadditionalcosts

Maybepainful(ifnopaincontrol).

Efficientinwoundswithasolidlayerofnecrotictissue

Suitableforexudativewoundsand,insomecases,

infectedwounds.

Costandresources:needforskilledstaff,anaesthesia,

treatmentroom/operationroometc

Maybeverytimeconsumingtoprovide

resourcesneeded

Riskofremovinghealthytissue

Riskofinfection,ifsterileconditionsarenotsecured

Notsuitableforpatientswithdecreasedperfusion

Specialprecautionsmustbetakenintoaccountwhen

treatingfunctionallyandcosmeticallyimportantareas.

Mosttime

consuming

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S 4 2