Debridement
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defining Stalled wounds
Stalled wounds are generally considered those that do not heal at least 15% in two weeks. For example: n Pressure ulcers that do not progress at least 39% in two weeks may not heal in a timely fashion 15 n Venous leg ulcers that do not heal at least 30% in two weeks will probably not heal in six months 16 n Diabetic ulcers that do not heal 30% in two weeks have only a 9% chance of healing in three months 17 goal Prepare the wound bed and promote moist wound healing. Tissue management T Moisture balance M Epithelial (edge) advancement E I Infection and inflammation control time Management Proper wound bed preparation is essential to promoting the wound healing process. Utilizing the Time Management protocol will help to keep that wound on track.
Autolytic debridement
uses the body’s own enzymes and moisture to re-hydrate, soften and finally liquefy eschar and slough. During autolysis, enzymes present in the wound have the effect of liquefying non-viable tissue. Clinicians foster autolytic debridement by utilizing moist wound dressings. By maintaining a moist wound environment, the body is able to use its own processes to eliminate necrotic tissue. Autolytic debridement can be achieved with the use of occlusive or semi-occlusive dressings which maintain wound fluid in contact with the necrotic tissue. It is virtually painless for the patient and safe, yet is generally slower than other forms of debridement. It can be used on its own, after surgical debridement, or in conjunction with enzymatic or mechanical debridement. Mechanical debridement is a process in which force is exerted on the necrotic tissue to rip, pull, push or abrade away the devitalized tissue from the healthy tissue. Mechanical debridement is often non-selective and may remove or cause damage to healthy tissue as well as necrotic tissue. Examples of mechanical debridement include wet-to-dry dressings, wound irrigation, pulsitile lavage, whirlpool, contact ultrasound and scrubbing the surface with gauze. Wet-to-dry dressings do not provide a moist wound healing environment and are not optimal for wound care once the wound is free of necrotic tissue. Sharp debridement is the removal of devitalized tissue by a skilled clinician, typically using a scalpel, scissors, curette or other sharp instrument. Clinicians use conservative sharp debridement to remove loosely adherent nonviable tissue at the bedside or in a clinical setting. Surgical debridement is done by a physician usually in the operating room, under anesthesia, with instruments and/or a laser when the tissue removal needs are extensive, or when the patient has a serious infection associated with the wound. Although sharp debridement is fast, it is non-selective and can be very painful to the patient. Enzymatic debridement, or chemical debridement, makes use of certain enzymes and other compounds to dissolve necrotic tissue. It requires a prolonged period of enzyme activity, and a moist wound environment with appropriate pH and temperature. Enzymes are inactivated by metals in some wound care products (silver, zinc). 18
in necrotic tissue by dissolving the collagen “anchors” that secure the avascular tissue to the wound bed. Collagenase has been shown to be most active within a pH range of 6 to 8.
19, 20
Biologic debridement uses maggots grown from the sterilized eggs of Lucilia sericata. The larvae are placed in the wound bed, where it is theorized that they secrete proteolytic enzymes that break down necrotic tissue, which they then ingest. This is considered an option when the patient is not a surgical candidate and has not responded to other methods of debridement. 13 Types of Debridement 2,4,5 The standard methods of debridement are autolytic, mechanical, enzymatic, sharp and biologic. The method of debridement used, often depends on the amount of necrotic tissue present in the wound bed, the extent of the wound, and the patient’s medical history and overall condition. Clinicians sometimes use more than one debridement method in conjunction in order to achieve the most successful removal of necrotic tissue. Continual vs. intermittent debridement It has been found that rates of healing increase when wounds are debrided more frequently. 4 With the increased knowledge of biofilms and their ability to repopulate, as well as the damaging effects of elevated proteases (MMP’s) of the chronic wound, more focus has been placed on continual debridement vs. single or intermittent debridement. Continual debridement provides a consistent action of removing necrotic tissue from the wound bed over a period of time, unlike single or intermittent methods. The ability to provide continual and consistent removal of necrotic tissue helps to create an optimal environment for healing and allows for less disruption to the wound bed.
The Role of
MEDIHONEY ® The overall goal for wound bed preparation is to remove factors that delay healing. 21 These factors in a stalled or chronic wound include necrotic tissue and altered levels and composition of wound exudates. MEDIHONEY ® dressings, containing Active Leptospermum Honey (ALH), address factors that cause delayed healing in chronic wounds. As demonstrated in multiple RCTs and 100s of clinical papers, ALH helps to jump start wounds and promote autolytic debridement due to its multiple mechanisms of action. MEDIHONEY ® ’s osmotic effect addresses multiple aspects of debridement quickly for optimal patient care. The high sugar content of MEDIHONEY ® aids in the increased flow of fluid to support the continual cleansing of the wound environment, helping to remove devitalized or necrotic tissue through an osmotic effect. 21, 22 Additionally, the low pH of MEDIHONEY ® helps to lower the pH levels within the wound environment, 9,27
which has been shown to have wound healing benefits. 28 5 Yüklə 5,69 Mb. Dostları ilə paylaş:
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