It’s important to understand that a given wound may have several treatment options that are equally appropriate for addressing the needs of that wound. While the desired result is the same — to create an optimal healing environment that facilitates speedy and efficient healing in an economical way — different clinicians may have different personal preferences, and one is not necessarily more correct than another. In addition, expense can be a factor while determining a course of treatment. A single treatment is generally preferable as multiple products or procedures can be more costly upfront, as well as incurring additional costs through an extended healing process. However, when assessing the course of treatment for a particular wound, the choice should always be driven by the condition of the wound bed and the surrounding tissue. If necrotic (dead) tissue is present, this tissue should be debrided as it inhibits the healing process. Debridement — the removal of non-viable tissue — is a necessary portion of wound care as it discourages bacteria growth and wound deterioration while encouraging healing growth factors. Even a small amount (5% or 10%) of necrotic tissue can contribute significantly to the risk of infection.
There are several different modalities of debridement:
Autolytic is the slowest method of debridement, using the body’s own enzymes to slowly eat away necrotic tissue. There are dressings available that aid in promoting a favorable environment for autolytic debridement. This method might be appropriate when debriding a small amount of tissue or you if you have already debrided and want to prevent reaccumulation.
There are certain types of wounds that may lend themselves to whirlpool, pulse lavage or wet-to-dry dressings, but this method of debridement is increasingly rare. It can be painful, as well as costly due to the required frequent changing of dressings. Mechanical debridement also kills healthy tissue in addition to the necrotic tissue.
Enzymatic debriding agents are chemical enzymes that debride necrotic tissue over a period of days or weeks. While effective, this method is expensive; the cost of the product used will need to be weighed against the benefit that’s being provided.
Surgical or Sharp
Surgical and sharp debridement
uses a scalpel or surgical scissors to remove necrotic tissue. When performed by a skilled clinician– and this method should only be performed by a trained physician or nurse practitioner, who can discern precisely what tissue requires debridement– surgical and sharp debridement
creates a favorable environment for healing most quickly while helping to prevent infection, in turn reducing costs. Sometimes not all necrotic material can be removed during debridement and several procedures may be necessary for optimal effect. It can continue to build up in between procedures if the cause has not been adequately addressed. If a wound continues to be non-healing after two to four weeks with no known cause for the healing delay, treatment should be reassessed at that time.