W ound bed preparation, particularly debridement, can be challenging. The research literature on wound debridement makes it difficult to compare effectiveness of various debridement methods. Each study looks at a different endpoint, which frequently is total wound healing. However, if a product is used specifically for debridement, that should be the endpoint.
Why worry about debridement? First, necrotic material in wounds harbors tremendous amounts of bacteria, increasing the likelihood of wound infection. Second, biofilm bacteria are more likely to attach to necrotic material than to living granulation tissue. Many debriding agents available do not directly affect bacteria or biofilm. In addition, wounds that are debrided slowly tend to become slow-healing or recalcitrant, nonhealing wounds.
Interventions performed in the early phases of care can make a difference in overall healing to prevent cells from becoming senescent and keep them from malingering in a chronic inflammatory phase. The literature underscores the fact that rapid, continual debridement can decrease the total time to wound closure, but information on debridement standards is limited. The standard originally published in the AHCPR Pressure Ulcer Treatment Guideline stipulates that progress toward healing should be expected in any wound within 2 to 4 weeks. Although this has been confirmed by several authors since that time, no one has set a standard of expectation for debridement. One article calls for significant progress toward debridement in 1 to 2 weeks, requiring clinicians to quantify the amount of necrotic tissue the first time a patient is seen and again in 1 to 2 weeks. Regardless of the debridement method used, clinically, it would make sense that significant progress should be noted.
Many clinicians have requested information on healing or debridement rates for various wound etiologies to allow easier comparison of product effectiveness. To adequately compare apples to apples, data need to be documented uniformly. This data can be used to track the rate of debridement. Tracking rates of debridement will assist clinicians as they monitor the appropriateness of therapy and rate of progress and make decisions regarding continuing treatment.
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 documentation were utilized. Patients with necrotic wounds who had already completed use of the activated polyacrylate dressing were studied. The size of the wound and the amount of necrotic material at the beginning and end of care with the activated polyacrylate dressing were compared. The mean rate of debridement was 38.11% per week. Many patients were completely debrided in just a few days.
The dressings consist of a polyacrylate dressing pad moistened with Ringer's solution. The pad, encased in a polypropylene pouch, has demonstrated an ability to attract and retain proteins such as those found in necrotic material, bacteria, and toxins. Activated polyacrylate dressings not only effectively keep the wound moist and support the autolytic debridement process, but they also seem to achieve debridement by another process as yet not documented in any of the literature. The rate of 38.11% per week is the highest rate that could be located among any published debridement studies.

Questions and Answers
QUESTION: For patients who had eschar, did they require "cross hatching" first or do you apply it to intact eschar?

CAROL PAUSTIAN: The dressing was used on intact eschar. None of the patients in this group had any documentation that they had received sharp debridement. Also, these wounds were not cleansed or debrided concurrently by any other products.

QUESTION: When you use this product for venous stasis ulcers, how do you maintain your compression?

CAROL PAUSTIAN: Many practitioners used compression stockings. The patients were asked to roll the stocking down or remove the stocking each day and replace the dressing and stocking. Some practitioners used two-part stocking systems because the stocking is easily pulled apart, the dressing set in place, and the stocking reapplied.