DEBRIDEMENT Professor Donald G. MacLellan Executive Director Health Education & Management Innovations

DEBRIDEMENT Principles - CSD Methods of Debridement Biopsy options

PRINCIPLES OF WOUND MANAGEMENT * 07/16/96 PRINCIPLES OF WOUND MANAGEMENT 1. DEFINE THE AETIOLOGY 2. CONTROL FACTORS AFFECTING WOUND HEALING 3. SELECT APPROPRIATE WOUND DRESSING / BANDAGE 4. PLAN WOUND HEALING MAINTENANCE *

Wound Management Identify and address underlying pathology Provide systemic support for wound healing Identify and treat infection Debride non-viable tissue Utilize appropriate topical therapy

WOUND BED PREPARATION OPTIMUM PREPARATION of a wound bed for tissue repair in the absence of vascular disease or medical contraindications is DEBRIDEMENT

WOUND BED PREPARATION DEBRIDEMENT THE REMOVAL OF +/- NON-VIABLE TISSUE +/- NECROTIC TISSUE +/- BIOFILM +/- DEBRIS +/- SENESCENT TISSUE FROM A WOUND.

Rationale for Debridement Non-viable Tissue: Is a culture medium for bacterial growth incl biofilms Inhibits WBC phagocytosis Causes a prolonged inflammatory response → impairs wound healing

Rationale for Debridement Senescent Tissue: Impaired cell proliferation Decreased extracellular matrix production May not respond to cytokine or growth factor stimulation due to receptor loss

Rationale for Debridement Peri-wound Callus: Causes pressure to underlying tissue during weight bearing/walking Impairs epithelialization from wound edges Provides undermined area for bacterial growth

Indications for Debridement Non-viable and/or senescent tissue Excessive fibrin in wound Peri-wound callus Significant colonisation/biofilm Adequate healing potential

Contraindications for Debridement Non-infected ischemic ulcer with dry eschar Inadequate circulation No potential for healing Risk of deep structure exposure/damage Risk of uncontrolled bleeding Uncooperative patient/inadequate facilities

Indications for Specialist Referral N Necrotic tissue present, not removed by superficial debridement. O Osteomyelitis, presence of infected bone, including tendon or muscle involvement, may need to be surgically debrided to allow healing to occur. H Hidden sinus tracts and/or tunnel, which have increased in size or are infected. E Eschar not removable by conservative sharp debridement or other methods of debridement. A Abscesses present & requiring to be surgically incised and drained to decrease the chance of systemic infection. L Large defects too large to close by secondary intention. I lschaemia. N Non-healing wound in spite of appropriate treatment. G Graft ready wound bed.

WOUND BED PREPARATION DEBRIDEMENT AUTOLYTIC ENZYMATIC MECHANICAL ULTRASONIC BIOLOGICAL SHARP

What method to choose? Wound characteristics: The patient's attitude - aetiology, size, infection, pain, exudate, location, involved tissues - required rate of debridement The patient's attitude Available skills & available resources Costs

Autolytic Debridement

Enzymatic Debridement Collagenase: Santyl Papain-Urea: -Accuzyme -Ethezyme™ -Ethezyme 830™ -Kovia Papain-Urea:Chlorophyllin Copper Complex: -Panafil -Ziox

Mechanical Debridement Wet-to-dry gauze Scrubbing wound Whirlpool Wound irrigation