Debridement Types

Question 1

Autolytic Debridement

Answer 1

• Selective
• Method of natural debridement promoted under occlusive or semi occlusive moisture-retentive dressings
• Results in solubilization of necrotic tissue only by phagocytic cells and by proteolytic and collagenolytic enzymes inherent in the tissues

Question 2

Autolytic Indications

Answer 2

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• Anticoagulant therapy
• Pts who can’t tolerate other types of debridement
• All necrotic wounds in people are medically stable
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Question 3

Autolytic Contraindications

Answer 3

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• Infected wounds
• Immunosuppressed pts
• Dry gangrene or dry ischemic wounds

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Question 4

Enzymatic Debridement

Answer 4

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• Method of chemical debridement that promotes liquefication of necrotic tissue by applying topical preparation of collagenolytic enzymes to those tissues<!--EndFragment-->

Question 5

Enzymatic Indications

Answer 5

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• All moist necrotic wounds
• Eschar after cross hatching
• Homebound individuals
• Pts who can’t tolerate surgical debridement

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Question 6

Enymatic Contraindications

Answer 6

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Ischemic wounds unless adequate vascular status has been determined

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Question 7

Mechanical Debridement

Answer 7

• Nonselective
• Method of debridement that removes foreign material and devitalized or contaminated tissue by physical forces, and may remove healthy tissue as well.
• Dressings which facilitate mechanical:
  
  • Wet to dry gauze
  • Dextranomers
  • Pulsatile lavage w/ suction
  • Whirl pool

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Question 8

Mechanical Indications

Answer 8

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Wounds with moist necrotic tissue

Foreign material present

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Question 9

Mechanical Contraindications

Answer 9

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Clean, granulating wounds

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Question 10

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Sharp Debridement

Answer 10

• Selective
• Method of debridement using sterile instruments, that sequentially removes only necrotic wound tissue without anesthesia
• Little or no bleeding induced in viable tissue
• *Scalpel, Scissors, Forceps, Silver nitrate stick

Question 11

Sharp Indications

Answer 11

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Scoring and/or excision of leathery eschar

Excision of moist necrotic tissue

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Question 12

Sharp Contraindications

Answer 12

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• Clean wounds
• Advancing cellulitis with sepsis
• When infection threatens the individuals life
• Anticoagulant therapy
• Coagulopathy

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Question 13

Surgical Debridement

Answer 13

• Selective
• For deep (Stage III or IV) or complicated ulcer, is the most efficient method of debridement.
• Uses sterile instuments by surgeon in a one-time operative procedure.
• The procedure usually removes most, in not all, necrotic tissue but may also remove some healthy tissue as well (wide excision).

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Question 14

Surgical Indications

Answer 14

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• Advancing cellulitis and sepsis
• Immunocompromised
• Infection threatens individual’s life
• Clean wounds as a preliminary procedure to surgical wound closure line
• Granulation and scar tissue may be excised

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Question 15

Surgical Contraindications

Answer 15

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• Cardiac dx
• Pulmonary dx
• Diabetes
• Severe spasticity
• Pts who can’t tolerate surgery
• Pts w. short life expectancy
• Quality of life cannot be improved

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Question 16

Kilohertz Ultrasound

Answer 16

• Selective
• Long wave, low frequency ultrasound typically operates between 20-50 kHz. Autoclaving is usually required (if direct contact is made)

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Question 17

Kilohertz Indications

Answer 17

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• Selective removal of necrotic tissue is desired
• Reduces bioburden
• Increases angiogenesis
• Wound bed preparation for grafting or flap closure

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Question 18

Kilohertz Contraindications

Answer 18

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• Vascular abnormalities
• Irradiated areas
• Tumors
• Organs
• Electrical Devices
• Precauations: over nerves, infections anesthic areas.

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Question 19

Biological Debridement

Answer 19

• The use of maggots to debride nonviable tissue.
• They produce enzymes and phagocytize necrotic tissue and bacteria (see below) and may stimulate granulation formation and epithelialization.
  
  • MRSA
  • Streptococcus (A and B)
  • Pseudomonas

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Question 20

Biological Indications

Answer 20

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• Individuals who can’t tolerate other forms of debridement
• All non-healing necrotic wounds in people who are medically stable

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Question 21

Biological Contraindications

Answer 21

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• Psychological stress arises from having living creatures in wounds
• Reports of pain increasing

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