In this article, we discuss a debridement being performed with a dermal curette. This is a debridement for the indication of a pressure ulcer that has yellow necrosis present within the base of the wound. This is often necrotic subcutaneous tissue or necrotic muscle or fascia. It is different from the black eschar, which is a leathery, more adherent type of necrosis.
Disclaimer: This demonstration is performed by a trained wound care physician with the usage of a pig foot and chicken fat to simulate a pressure ulcer with yellow necrosis. This article demo is for educational purposes only and should not be tried at home.
Initially, a dermal curette, 4 millimeters has been selected. The dermal curette has cutting edges on both sides of a circular blade. It is commonly held in a pen-like fashion. It’s applied at a 45-degree angle to the wound bed. It is important to maintain the curette parallel to the surface of the wound as turning it on edge will produce a knife-like application.
Using short strokes, the physician will begin to remove the necrotic tissue from the underlying healthy tissue as demonstrated in this video. It’s important to use short strokes and apply uniform pressure as any erratic movements can result in a deeper incision which might lead to hemorrhage.
Prior to performing a debridement, it’s essential to achieve adequate anesthesia so as not to cause any discomfort to the patient. This can be achieved using topical benzocaine or injectable anesthetic such as lidocaine.
As the debridement progresses, you will see that the yellow necrotic tissue is removed. Any underlying capillaries that are bleeding can be easily controlled with pressure and the wound can finally be cleansed with saline to remove any lose debris.
Yellow Necrosis Removal
Alternatively, a 15-blade scalpel and forceps can be used to perform debridement of yellow necrosis. Commonly, this is achieved for a larger wound or a wound that has more adherent yellow necrosis then might be removed easily with a dermal curette. A dermal curette often times, the blade will fill with the necrotic tissue being removed and will necessitate more than one instrument.
The scalpel and forceps instrumentation is being used to remove yellow necrosis. Short, even strokes are being applied with minimal pressure being directed into the base of the wounds. This will prevent injury to underlying structures as well as minimize any bleeding that may occur.
If there are tendons or sensitive critical structures within the base of the wound, these can be avoided and carefully debrided around to avoid underlying injury.