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