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

2. DEBRIDEMENT
Principles - CSD
Methods of Debridement
Biopsy options

3. 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 *

4. 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

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

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

7. 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

8. 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

9. 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

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

11. 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

12. 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.

13. WOUND BED PREPARATION DEBRIDEMENT AUTOLYTIC ENZYMATIC MECHANICAL
ULTRASONIC
BIOLOGICAL
SHARP

14. 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

15. Autolytic Debridement

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

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

18. Maggot Debridement Therapy
Larvae of Lucilia sericata (greenbottle fly)

19. Conservative Sharp

20. Vascular Considerations
Clinical Examination
Ensure adequate local tissue perfusion
ABI > 0.5
TcPO2 > 30 mm Hg

21. Conservative Sharp Debridement - Procedure

22. Instruments

23. Facilities Consented, cooperative patient
Analgesia/anaesthesia assessment/Tx
Relatively undisturbed environment
Adequate lighting
Adjustable height of bed/trolley/couch
Sterile instruments & protective equipt
Scout
Dressings/bandages

24. Biopsy Techniques

25. What is a skin biopsy?
Skin biopsy is a biopsy technique in which a portion of or all of a skin lesion is removed.
This is sent to a pathologist for microscopic diagnosis.
It is usually done under local anaesthetic in an ambulatory setting.
The pathology results are generally available within 2-4 days.
Commonly performed by medical practitioners.
Important procedure for diagnosis of skin conditions

26. Tissue Biopsy for Diagnosis
Malignancies
Inflammatory conditions
Vasculitic syndromes
Dermatological disorders

27. Types of Biopsies Shave Punch* Incisional* Excisional
*Used most commonly in wound care

28. Tissue Biopsy: Equipment

29. Shave Biopsy

30. Punch Biopsy

32. Excisional Biopsy

33. Tissue Biopsy for Diagnosis
Clinical information essential
Location and timing are crucial to an accurate diagnosis
Biopsy newest lesions along the advancing edge of the abnormal area, including a rim of normal tissue

34. Biopsy: Relative Contraindications
Bleeding disorders/anticoagulation therapy
Immunosuppression
Severe peripheral arterial disease
Known or possible underlying vital structures

35. Debridement & Biopsy Summary
Understand the pathophysiology of wounds
Determine patient eligibility for debridement and biopsy
Develop & follow protocols
Acquire proper training/experience
Understand your scope of practice