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Debridement
Debridement is the removal of devitalized tissue.
Preparing the Wound for Healing: The Effect of Activated Polyacrylate Dressing on Debridement
Activated polyacrylate dressings facilitate wound debridement by retaining moisture while attracting and retaining proteins and bacteria. A 55-patient retrospective study was conducted to quantify the effect of this dressing on debridement of chronic wounds in clinical practice. All patients attended one of four outpatient wound clinics between June 1, 2001 and February 10, 2002 and received treatment with the polyacrylate dressing for an average of 3.9 weeks (SD 4.1). During that time, the rate of wound necrotic tissue debridement was 37.7% per week. Older patients (>80 years of age) had significantly lower rates of wound debridement (mean 18.1% per week) than those <51 years of age (mean 36% per week, P = 0.009). Other variables (age, wound type, wound duration and diagnosis of diabetes) were not found to significantly affect the rate of wound debridement. Wound debridement rates of commonly available modalities are largely unknown. However, these results suggest that activated polyacrylate dressings are an effective, atraumatic, and easy-to-use method of debriding chronic wounds.
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Managing a Traumatic Wound in a Geriatric Patient
Clinical management of a wound in a geriatric patient requires an understanding of age-related changes in the skin and the knowledge to make appropriate treatment choices. This case study describes clinical assessment and management of a traumatic hip wound in a 75-year-old patient. In addition to addressing his nutritional status by providing supplements, topical wound care preparations, including papain-urea and castor oil/balsam of Peru/trypsin, were used as a conservative approach to address debridement and periwound skin concerns. Extra vigilance is required to assess wounds in geriatric patients to determine proper wound treatment and achieve optimum results. Additional studies to evaluate optimal treatment strategies in the clinical management of traumatic wounds in the geriatric population are needed.
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Debridement Rates with Activated Polyacrylate Dressings (TenderWet(R))
Why worry about debridement? Many clinicians have requested information on healing or debridement rates for various wound etiologies to allow easier comparison of product effectiveness. To document the rate of debridement for the new activated polyacrylate dressings, data from wound care clinics where WOC certified nurse practitioners managed the wound care and ...
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Comparison of Wound Irrigation and Tangential Hydrodissection in Bacterial Clearance of Contaminated Wounds: Results of a Randomized, Controlled Clinical Study
Thorough irrigation of contaminated or infected traumatic and open surgical wounds is considered standard practice. High-power pulse lavage is frequently used to facilitate the removal of surface contaminants and bacteria but studies to compare the results of various irrigation techniques are limited. The purpose of this randomized, controlled clinical study was to compare the ability of a high-pressure parallel waterjet (pressure range 5,025 to 7,360 psi) to pulse lavage (pressure 40 psi) in reducing wound bacterial counts. The higher velocity instrument utilizes a waterjet oriented parallel to the surface of the wound and can be used to cut and remove necrotic tissues. After obtaining informed consent, 21 patients who presented with open surgical and traumatic wounds were randomly assigned to high-pressure parallel waterjet (n = 12) or pulse lavage (n = 9). Pre- and post irrigation tissue culture results showed an average decrease in absolute bacterial counts of 90.8% in the high-pressure parallel waterjet and 86.9% in the pulse lavage group. The difference between the two treatment groups was not statistically significant. The results of this study confirm that cleansing contaminated or infected acute wounds using high pressure (at least 15 psi) reduces wound bacterial counts. Studies to compare the clinical outcomes of various irrigation techniques and pressure ranges are warranted and the potential benefit of selective debridement using the high-pressure parallel waterjet should be investigated. KEYWORDS: debridement, wound irrigation, waterjet, bacterial counts, wound contamination
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Negative Pressure Wound Therapy: ?A Rose by Any Other Name?
Negative pressure wound therapy is one of the dominant adjunctive wound care modalities used in North America. One company has a proprietary hold on the market for this type of wound therapy and recent wound care literature has focused on the company?s products rather than on the concept itself. Currently utilized standards for negative pressure wound therapy are based on a few relatively recent publications originating after 1997. However, a review of the English and Russian literature that predates this work reveals discrepancies regarding optimal duration of treatment, intensity of negative pressure, mode of application, timing of application, and intervals between treatments. A careful review of research that has rarely been cited in recent wound care literature elucidates the inconsistencies between currently held dogma and less well known negative pressure research. In order to achieve optimal outcomes of care, current practices must be re-evaluated and researched using well-established guidelines for determining treatment safety and effectiveness. KEYWORDS: negative pressure, VAC, vacuum, Russian Ostomy/Wound Management 2005;51(3):44?49
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The Mysterious Calciphylaxis: Wounds with Eschar ? To Debride or Not to Debride?
Calciphylaxis is a confusing disease process that affects people with end-stage renal disease. The prognosis of this increasingly common condition is poor and mortality rates range from 60% to 80% related to wound infection, sepsis, and organ failure. Its presenting sign is skin necrosis related to calcification of the arteriole microvasculature. The disease is painful and debilitating, particularly due to the necrotic wounds. Aggressive wound care to prevent infection is vital when eschar does not protect the wound and drainage is present, but debridement is contraindicated for wounds covered with dry, noninfected eschars. The decision to debride is based on the patient?s total clinical picture. Patients with calciphylaxis have poor healing potential due to ischemia and comorbidity factors such as diabetes mellitus, peripheral vascular disease, and obesity. The goal of care is prevention of infection and pain management. Some of the sensitizers and challengers responsible for the chemical imbalance leading to the arteriole calcification, as well as risk factors and clinical manifestations of calciphylaxis, are reviewed. A discussion of treatment focuses on wound care of stable necrotic ulcers and a case report illustrating the progression of calciphylaxis is presented.
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A Survey of Current Physical Therapy Practices in Wound Care
Few standardized treatment protocols are available to guide physical therapists through the rapidly changing area of wound care. To assess current physical therapy practices and to determine relationships between specific demographic data and evaluation/intervention techniques utilized in wound care, a questionnaire was developed that used a Likert scale (1 to 5) for responses, offering choices from "always" to "never." The questionnaire was sent to physical therapists at 170 clinical sites used by the University of Mary Program in Physical Therapy in Bismarck, ND. The final return rate was 48.1%. The most commonly used evaluation and intervention techniques were determined. Use of the rubor of dependency test, sharp debridement, enzymatic debridement, compression dressings, and autolytic debridement was found to have a significant (P < .05) relationship to the reported percentage of compromised wound care patients in a clinician's practice; whereas, years of clinician experience has a significant (P < .05) relationship to the use of monofilament testing and the use of electrical stimulation. Reasons for the differences observed, including the role of guidelines, need to be explored.
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Ultrasound Therapy for Recalcitrant Diabetic Foot Ulcers: Results of A Randomized, Double-Blind, Controlled, Multicenter Study?Part 2
Part 2 - Discussion The ultrasound therapy described in this study employs a recently FDA-cleared device for the cleansing and debridement of wounds with an expanded indication (promotes healing). An attempt was made to design a trial that addressed many of the previous shortcomings of both ultrasound and diabetic foot ulcer studies. Conclusion Ultrasound therapy has...
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Ultrasound Therapy for Recalcitrant Diabetic Foot Ulcers: Results of A Randomized, Double-Blind, Controlled, Multicenter Study?Part 1
An estimated 15% of patients with diabetes will develop a foot ulcer sometime in their life, making them 30 to 40 times more likely to undergo amputation due to a non-healing foot ulcer than the non-diabetic population. To determine the safety and efficacy of a new, non-contact, kilohertz ultrasound therapy for the healing of recalcitrant diabetic foot ulcers ? as well as to evaluate the impact on total closure and quantitative bacterial cultures and the effect on healing of various levels of sharp/surgical debridement ? a randomized, double-blinded, sham-controlled, multicenter study was conducted in hospital-based and private wound care clinics. Patients (55 met criteria for efficacy analysis) received standard of care, which included products that provide a moist environment, offloading diabetic shoes and socks, debridement, wound evaluation, and measurement. The ?therapy? was either active 40 KHz ultrasound delivered by a saline mist or a ?sham device? which delivered a saline mist without the use of ultrasound. After 12 weeks of care, the proportion of wounds healed (defined as complete epithelialization without drainage) in the active ultrasound therapy device group was significantly higher than that in the sham control group (40.7% versus 14.3%, P = 0.0366, Fisher?s exact test). The ultrasound treatment was easy to use and no difference in the number and type of adverse events between the two treatment groups was noted. Of interest, wounds were debrided at baseline followed by a quantitative culture biopsy. The results of these cultures demonstrated a significant bioburden (>105) in the majority of cases, despite a lack of clinical signs of infection. Compared to control, this therapeutic modality was found to increase the healing rate of recalcitrant, diabetic foot ulcers. KEYWORDS: ultrasound, debridement, diabetic foot ulcer, randomized controlled trial, wound modalities Ostomy/Wound Management 2005;51(8):24?39
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Outcomes of Subatmospheric Pressure Dressing Therapy on Wounds of the Diabetic Foot
The purpose of this retrospective study was to evaluate outcomes of people with large diabetic foot wounds treated with subatmospheric pressure dressing therapy immediately following surgical wound debridement. Data were abstracted from the medical records of 31 consecutive patients with diabetes, 77.4% male (n = 24), aged 56.1 ± 11.7 years, presenting for care at two large multidisciplinary wound care centers. All patients received surgical debridement for indolent diabetic foot wounds and were subsequently started on a regimen of subatmospheric pressure dressing therapy delivered using a vacuum-assisted closure device for a mean of 4.7 ± 4.2 weeks (mode = 2 weeks) using a protocol that called for cessation of therapy when the wound bed approached 100% coverage with granulation tissue with no exposed tendon, joint capsule, or bone. Outcomes evaluated included time to complete wound closure, proportion of patients achieving wound healing at the level of initial debridement, and complications associated with use of the device. The mean duration of wounds before therapy was 25.4 ± 23.8 weeks. In patients treated with subatmospheric pressure dressing therapy, 90.3% (n = 28) of wounds healed at the level of debridement without the need for further bony resection in a mean 8.1 ± 5.5 weeks. The remaining 9.7% (n = 3) went on to higher level amputation (below knee amputation = 3.2%, [n = 1] and transmetatarsal amputation = 6.5% [n =2]). Complications included periwound maceration (19.4% [n = 6]), periwound cellulitis (3.2% [n = 1]), and deep space infection (3.2% [n = 1]). The authors concluded that appropriate use of subatmospheric pressure dressing therapy to achieve a rapid granular bed in diabetic foot wounds may have promise in treatment of this population at high risk for amputation and that a large, randomized trial is now indicated.
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