Methods Of Debridement

Question 1

Selective method of natural debridement promoted under occlusive or semiocclusive moisture-retentive dressings that results in soluabilization of necrotic tissue only by phogyocytotic cells and by rote Olympic and collagenolytic enzymes inherent in the tissues

Answer 1

Autolytic

Question 2

Selective method of chemical debridement that promotes liquification of necrotic tissue by applying topical preparation of collagenolytic enzymes to those tissues

Answer 2

Enzymatic

Question 3

NONSELECTIVE method of debridement that removes foreign material and devitalized or contaminated tissue by physical forces- may remove healthy tissues as well

Answer 3

Mechanical

Question 4

SELECTIVE method of debridement using sterile instruments (scalpel, scissors, forceps, silver nitrate stick) that sequentially removes only necrotic wound tissue without anesthesia and with little/no bleeding induced in viable tissue

Answer 4

Sharp

Question 5

For deep (stage III or IV) or complicated pressure ulcer, most efficient method of debridement.

Answer 5

Surgical

Question 6

What is the method?
It is selective and performed by physician/surgeon using sterile instruments (scalpel, scissors, forceps, hemostat, silver nitrate sticks) in a one-time operative procedure. Procedure removes most, if not all, of the neurotic tissue but may also remove some healthy tissue in what is called ___ ___.

Answer 6

Surgical

Wide excision

Question 7

Long-wave low frequency ultrasound typically operates between 20 and 50 kHz. Selective form of debridement.

Answer 7

Kilohertz Ultrasound

MIST, Sonaca 180, Misonix device

Question 8

Autoclaving of contact probe usually required (not all devices make direct contact with wound). What type of method?

Answer 8

Kilohertz Ultrasound

Question 9

Use of maggots to debridement nonviable tissue. Produce enzymes and phagocytize necrotic tissue and bacteria (MRSA, group A and B streptococcus, Pseudomonas). May stimulate granulation formation and epithelialization.

Answer 9

Biological (rarely used)

Question 10

Indications for autolytic debridement

Answer 10

1. Anticoagulant therapy
2. If cannot tolerate other forms of debridement
3. All necrotic wounds in people who are medically stable

Question 11

Contraindications for autolytic debridement

Answer 11

1. Infected wounds
2. Wounds of immunosuppressive individuals
3. Dry gangrene or dry ischemic wounds

Question 12

Indications for enzymatic debridement

Answer 12

1. Moist, necrotic wounds
2. Eschar after cross-hatching
3. Homebound individuals
4. If cannot tolerate surgical debridement

Question 13

Contraindications for enzymatic debridement

Answer 13

1. Ischemic wounds unless adequate vascular status has been determined
2. Dry gangrene
3. Clean, granulated wounds

Question 14

Indications for mechanical debridement

Answer 14

1. Wounds with moist necrotic tissue or foreign material present

Question 15

Contraindications for mechanical debridement

Answer 15

1. Clean, granulated wounds

Question 16

Indications for sharp debridement

Answer 16

1. Scoring and/or excision of leathery eschar

2. Excision of moist necrotic tissue

Question 17

Contraindications for sharp debridement

Answer 17

1. Clean wounds
2. Advancing cellulitis with sepsis
3. When infection threatens pt’s life
4. On anticoagulant therapy or has coagulopathy

Question 18

Indications for surgical debridement

Answer 18

1. Advancing cellulitis with sepsis
2. Immunocompromised individuals
3. When infection threatens life
4. Clean wounds as preliminary procedure to surgical wound closure line
5. Granulation and scar tissue may be excised

Question 19

Contraindications for surgical debridement

Answer 19

1. Cardiac disease, pulmonary disease, diabetes
2. Severe spasticity
3. Individuals who cannot tolerate surgery
4. Individuals with short life expectancy
5. QOL cannot be improved

Question 20

Indications for Kilohertz Ultrasound

Answer 20

1. Selective removal of necrotic tissue desired
2. Reduces bioburden
3. Increase angiogenesis
4. Wound bed prep for grafting or flap closure

Question 21

Contraindications for Kilohertz US

Answer 21

1. Vascular abnormalities (DVT, emboli, advanced PVD), irradiated areas, tumors, organs, electrical devices
2. PXNs: over nerves, infections, anesthetic areas

Question 22

Indications for biological debridement

Answer 22

1. Individuals who cannot tolerate other forms of debridement
2. All non-healing necrotic wounds in people who are medically stable

Question 23

Contraindications for biological debridement

Answer 23

1. Psychological stress arises from having living creatures in wounds (eew)
2. Reports of pain increasing

Question 24

Name the selective debridement methods

Answer 24

1. Autolytic
2. Enzymatic
3. Sharp
4. Surgical
5. KHz US
6. Biological??

Question 25

Name the non selective debridement method(s)

Answer 25

1. Mechanical