Debridement

Question 1

Sharp Debridement

Answer 1

-scalpel, scissors, tools
-gold standard
-Serial: loose necrotic, over several visits, not painful, maintenance
-Selective: cut out tissue, may bleed

Function/Purpose:
-large amount of tissue, callous, or bioburden

Pros:
-quickest

Cons:
-painful

Contraindications:
-gangrene, dry heel ulcer, redness, black covering, arterial in., can’t see or identify

Question 2

Debridement

Answer 2

-removal of dead tissue, foreign materials, and debris from wound
-foundation of wound bed prep

Improves:
-assessment, bioburden/infection, growth factors, senescent cells, chronic to acute wound, inflammatory phase, odor, topicals

Containdications:
-granulation tissue
-stable/dry eschar in ischemic limb
-deeper tissue needs
-unable to see
-cannot identify

Question 3

Selective Debridement

Answer 3

-sharp
-autolytic
-enzymatic
-biological

Question 4

Non-Selective Debridement

Answer 4

-mechanical
-surgical

Question 5

Autolytic Debridement

Answer 5

-natural promotion of liquification of dead tissue
-maintenance between serial debridements
-helped with crosshatching

Function/Purpose:
-phagocytes soften and macrophages eat dead tissue
-promote by covering with moisture retentive dressing for 72h

Pros:
-pain free

Cons:
-slow
-must have good vascular flow
-not for infected wound

Contraindications:
-infected wounds
-deep cavities

Question 6

Enzymatic Debridement

Answer 6

-Collagenase (santyl)
-digests collagen and other parts of dead tissue
-can score or hatch
-maintenance

Function/Purpose:
-works from the bottom, up
-most effective in moist wound
-deactivated by metals

Cons:
-requires prescription
-increased drainage
-slow

Contraindications:
-dry wound
-granulation tissue
-infected wounds
-emergent cases
-facial wounds
-deep tissues

Question 7

Biological Debridement

Answer 7

-maggots

Function/Purpose:
-tea bag or free range
-chronic wound management
-liquify necrotic tissue and biofilm

Pros:
-doesnt harm healthy tissue

Cons:
-ick factor
-removal/disposal
-placement

Contraindications:
-life or limb threatening wound
-bleeding issues
-deep tracking wounds
-location of pressure

Question 8

Wound Irrigation

Answer 8

Function/Purpose:
-use saline with light pressure to clean out a wound

Pros:
-doesnt harm granulation tissue

Question 9

Mechanical Debridement

Answer 9

-irrgation, scrubbing, cleansing, wet-to-dry, whirlpool, pulsatile lavage, ultrasound

-painful
-nonselecttive
-can be traumatic and cause inflammation

Question 10

Wounds Scrubbing

Answer 10

Function/Purpose:
-scrub from the center out
-using guaze or sponge

Pros:
- good for slough

Cons:
-can damage granulating cells

Question 11

Wound Cleansing

Answer 11

Function/Purpose:
-like scrubbing but with cleanser

Cons:
-cleansers not regulated

Question 12

Wet-to-Dry

Answer 12

Function/Purpose:
-pulls off dead tissue when dries

Cons:
-painful when drys
-labor intensive
-can cause maceration
-costs more
-increased infection risk

Question 13

Whirlpool

Answer 13

-c level evidence

Function/Purpose:
-increases blood flow
-icnreases healing
-increased fibroblasts

Cons:
-can lead to maceration
-labor intensive

Contraindications:
-maceration
-febrile
-venous insufficiency
-neuropathy
-infections
-dry gangrene
-incontinence

Question 14

Pulse Lavage with Suction

Answer 14

-4-8psi

Function/Purpose:
-positive pressure saline then negattive to suction away
-for tracts, tunnels, and undermining

Pros:
-can be done bedside
-quick

Cons:
-non selective

Contraindications:
-exposed stuff
-cavities
-facial wounds
-recent graft
-anticoagulants

Question 15

Ultrasound

Answer 15

-new

Pros:
-antimicrobial

Contraindications:
-pregnant uterus, gonads, malignancies, DVT, eyes, laminectomy, hemophiliac

Question 16

Surgical Debridement

Answer 16

-sharps in strile environment by physician

Function/Purpose:
-when inflammation of surrounding tissues
-extensive undermining
-septic
-near organs

Cons:
-nonselective