Pearls for Practice: Hydroconductive Dressings Used to Minimize Debridement

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Daphne Denham, MD; Sandi E. Jiongco, MSN, FNP-C, CWCN, WCC, DWC; and Martin C. Robson, MD Comprehensive Wound Care, Northbrook, IL; and University of South Florida, Tampa, FL

Wound bed preparation is the management of a wound in order to accelerate endogenous healing or to facilitate the effectiveness of other therapeutic measures.1 To effect wound bed preparation, it is necessary to debride necrotic tissue and debris, decrease excessive wound exudate, decrease the tissue bacterial level, remove deleterious chemical mediators, and set the stage for acceleration of endogenous healing or wound closure.2 Debridement can be accomplished in multiple ways, including surgical, mechanical, enzymatic, biological, and autolytic methods.3 Although Steed et al4 showed sharp debridement resulted in increased healing rates, overly aggressive debridement can delay the healing process. Unfortunately, the fee-for-service sharp debridement model can unnecessarily increase the frequency and extent of debridement.5 owm_1017_pearls_figure1

Drawtex Hydroconductive Wound Dressings (SteadMed Medical LLC, Fort Worth, TX) have demonstrated the ability to draw out exudate, debris, bacteria, and deleterious cytokines, once obvious necrotic and/or devitalized tissue has been removed, to complete wound bed preparation without excessively removing viable tissue that may be important to the healing wound.2 Three (3) illustrative cases demonstrate effectiveness of the Drawtex dressings.

Case 1.  A 76-year-old man with diabetes, chronic renal disease, bilateral pedal edema, and a 3.0 cm x 3.5 cm ulcer underwent sharp debridement of obvious necrotic tissue and then was provided Drawtex dressing changes 3 times per week. Figures 1A–D illustrate healing progress after 1, 2, 3, and 7 weeks, respectively, of Drawtex dressing treatment. 

Case 2.  A 75-year-old woman had a traumatic skin flap to her pretibial area, shown at the time of presentation before debridement of the obviously necrotic flap (see Figure 2A). The wound measured 4.0 cm x 5.0 cm after 3 weeks of treatment with Drawtex dressings (see Figure 2B) and was almost completely epithelialized after 4 weeks of Drawtex dressings (see Figure 2C). owm_1017_pearls_figure2

Case 3. A 74-year-old woman with a pretibial ulcer of unknown etiology measuring 8.5 cm x 7.0 cm is shown at time of presentation (see Figure 3A). Following sharp debridement of the nonviable tissue, Drawtex dressings were provided 3 times per week at dressing changes. The wound is shown after 1 week of dressing changes (see Figure 3B), after 7 weeks (see Figure 3C), and essentially healed after 9 weeks of Drawtex dressing changes (see Figure 3D). owm_1017_pearls_figure3             

In these 3 examples, hydroconductive wound dressings were applied 3 times per week to remove small areas of nonviable tissue and debris, facilitate wound bed preparation, and achieve wound closure while avoiding excessive sharp debridement. These cases demonstrate hydroconductive dressings can eliminate the necessity for repeated sharp debridement and can facilitate wound closure.

References  

1. Schultz GS, Sibbald RG, Falanga V, et al. Wound bed preparation: a systematic approach to wound management. Wound Repair Regen. 2003;11(1 suppl):S1–S28. 

2. Robson MC. Advancing the science of wound bed preparation for chronic wounds. Ostomy Wound Manage. 2012;58(11):10–12. 

3. Franz MG, Robson MC, Steed DL, et al; Wound Healing Society. Guidelines to aid healing of acute wounds by decreasing impediments of healing. Wound Repair Regen. 2008;16(6):723–748. 

4. Steed DL, Donohoe D, Webster MW, Lindsley L. Effect of extensive debridement and treatment on healing of diabetic foot ulcers. Diabetic Ulcer Study Group. J Am Coll Surg. 1996;183(1):61–64. 

5. Belken T, Mozen N. Current and emerging modalities in wound debridement. Podiatry Today. 2013;26(8):32–33.