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Wound Debridement: 4 methods of wound debridement

         Wound debridement is a process to remove the waste, exudate, and necrotic tissues from the wound. The necrotic tissues hold back the healing process as it is one of the mediums where bacteria grow.

What is the purpose of debridement?

The prime motive of debridement is to control and prevent the occurring of infection and also to reduce the bioburden. The debridement also has a role in improving the healing process, and along with that it also helps in restoring circulation and oxygen.

What is the reason for the accumulation of necrotic tissues?

The common reasons for the accumulation of necrotic tissues are:

  1. Poor blood supply.
  2. Increased interstitial pressure.
  3. Pressure ulcer in the wound. 
Examination of the necrotic tissues:
  • When the severity of necrotic increases, the color changes from the white-gray to tan or yellow, and in the end it changes into brown or black.
  • In the beginning, the consistency will be mucoid mucus-like and their water content will be high. 
  • There is the change occurs in the consistency of necrotic tissue as the tissue becomes dry. 
  • Eventually, the appearance of tissue will be dry, lathery, and hard. 
How does necrotic tissue appear at different levels?
  • The cluster of stringy yellow slough is created when the subcutaneous fat tissue dies. 
  • The dead tissue will become thicker with the degeneration of muscle tissue. 

What happens after debridement? 

The macrophages take on in the starting of the cleaning process. The induct fibroblasts that deposit collagen and fill the wound with scar tissue. 

What are the methods of wound debridement?
 The methods of wound debridement are:
  1. Mechanical debridement 
  2. Enzymatic debridement
  3. Autolytic debridement
  4. Sharp surgical debridement
1. Mechanical Debridement:
Mechanical debridement method help in removing the waste and unhealthy tissues utilizing the moving force.  This method is non-selective between viable and non-viable tissues. The further types of  mechanical debridement are:
  •  Wet to dry dressing: This is a common method in all health care systems.  A saline gauze dressing is allocated on the wound surface. We can remove it when it becomes dry. This method is useful when surgical intervention is not an immediate option. 
  • Hydrotherapy: In this method, we use running water to filter the old tissue. This method is useful when there is a need for aggressive cleaning for softening of necrotic tissue in large wounds. In granulation wounds, this method is contraindicated because it can dry and injure the wound bed.
2. Enzymatic Debridement: 

It is one of the easy-to-use, safe, and effective methods because we just use the gel or ointment in this method. The gel or ointment contains the enzymes which soften the unhealthy tissue. It is the perfect method for patients who don't want to go for surgery and not are in a position to go for surgery. Topical enzymatic agents digest and dissolve necrotic tissues in the wound bed. 

3. Autolytic Debridement: 

In autolytic debridement, the body uses natural fluid and endogenous enzymes .i.e. the body's enzymes to get rid of wounds of necrotic tissue. It is applied in superficial wounds with little necrotic tissue. It requires adequate circulation as well as nutrition. Autolytic debridement takes a lot of time but is less harmful. 

4. Sharp Surgical Debridement: 

In sharp debridement, the unhealthy and harmful tissues are cut off.  The sharp debridement is done first when the infection is spread to cellulitis. The patient must not be on anticoagulant therapy when performing sharp debridement. This method is done by experienced physicians as well as surgeons. In some states, the nursing and physiotherapist need a license to perform this method. 

Conclusion:
This article covers the basic detail of wound debridement and its methods. We have covered all the methods in such a way so that everyone can understand them easily. 


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