It is vital that all foreign matter and contaminated, devitalized or dead tissue be removed from wounds as first steps in preparing wound bed. The process of removing these substances is what clinicians refer to as wound debridement. All forms of non-viable tissue in wounds are referred to as slough or necrotic tissue. Necrotic tissue has a brown or black coloration while slough is colored yellow and is fibrinous.
Chronic wounds will often have a buildup of necrotic tissue. The necrotic tissue is composed of necrotic material, high bacterial levels, exudate, and non-viable tissue. As opposed to other forms of wounds, chronic wounds tend to accumulate necrotic tissue more. Chronic wounds result because of diabetes, venous insufficiency and other underlying and uncorrected pathogenic abnormalities. Often, these abnormalities are insolvable. Thus, preparing wound beds so as to facilitate closure of wounds become necessary.
Debridement is important due to a number of reasons. First, devitalized tissue need to be removed to allow the clinician to be able to assess how deep wounds are and to know what condition surrounding tissues are in. The second reason is that necrotic tissues often mask symptoms of local infections in the wound. Finally, when necrotic tissue is present, it serves as a physical barrier to the healing process and also significantly supports growth of bacteria.
Bacterial colonies contained in necrotic tissues create damaging proteases. Proteases negatively affect reepithelialization process and production of granulation tissues. As such, by debriding wounds the likelihood of contamination and destruction of tissue is reduced greatly. It is the elimination of cell debris that contribute to reduced tissue destruction.
There are four main methods of debriding wounds, that is, mechanical, autolytic, surgical or sharp, and enzymatic. Which method is chosen for debriding is made based on several factors. Some of the factors include the type, position, and size of wounds, pain management, time available for the process, moisture levels, and the healthcare setting. The overall condition of the patient is also considered a lot when choosing the methods to be used. Sometimes multiple methods may be employed at once.
Surgical or sharp debriding procedure is the fastest method to use in removing debris and necrotic tissues from wound beds. This approach is most suitable when the clinician cannot tell the depth of wounds due to presence of excess necrotic tissue. It is also the best option for removing infected materials and bones.
The surgical approach presents many benefits to patients. To begin with, damage of surrounding tissues is done to the minimal. Secondly, Repairing of wounds is made possible by slight bleeding that results. Wounds are repaired by cytokines and other inflammatory mediators released through bleeding. A thorough assessment of the patient must be done to ensure that they are suitable candidates for this procedure.
There are many shortcomings associated with this approach too. First, it can only be used on individuals with uncompromised immune systems and no bleeding disorder of any kind. Secondly, it results in transient bacteremia and patients may feel a lot of pain at times. Finally, tendons and nerves get damaged sometimes.
Chronic wounds will often have a buildup of necrotic tissue. The necrotic tissue is composed of necrotic material, high bacterial levels, exudate, and non-viable tissue. As opposed to other forms of wounds, chronic wounds tend to accumulate necrotic tissue more. Chronic wounds result because of diabetes, venous insufficiency and other underlying and uncorrected pathogenic abnormalities. Often, these abnormalities are insolvable. Thus, preparing wound beds so as to facilitate closure of wounds become necessary.
Debridement is important due to a number of reasons. First, devitalized tissue need to be removed to allow the clinician to be able to assess how deep wounds are and to know what condition surrounding tissues are in. The second reason is that necrotic tissues often mask symptoms of local infections in the wound. Finally, when necrotic tissue is present, it serves as a physical barrier to the healing process and also significantly supports growth of bacteria.
Bacterial colonies contained in necrotic tissues create damaging proteases. Proteases negatively affect reepithelialization process and production of granulation tissues. As such, by debriding wounds the likelihood of contamination and destruction of tissue is reduced greatly. It is the elimination of cell debris that contribute to reduced tissue destruction.
There are four main methods of debriding wounds, that is, mechanical, autolytic, surgical or sharp, and enzymatic. Which method is chosen for debriding is made based on several factors. Some of the factors include the type, position, and size of wounds, pain management, time available for the process, moisture levels, and the healthcare setting. The overall condition of the patient is also considered a lot when choosing the methods to be used. Sometimes multiple methods may be employed at once.
Surgical or sharp debriding procedure is the fastest method to use in removing debris and necrotic tissues from wound beds. This approach is most suitable when the clinician cannot tell the depth of wounds due to presence of excess necrotic tissue. It is also the best option for removing infected materials and bones.
The surgical approach presents many benefits to patients. To begin with, damage of surrounding tissues is done to the minimal. Secondly, Repairing of wounds is made possible by slight bleeding that results. Wounds are repaired by cytokines and other inflammatory mediators released through bleeding. A thorough assessment of the patient must be done to ensure that they are suitable candidates for this procedure.
There are many shortcomings associated with this approach too. First, it can only be used on individuals with uncompromised immune systems and no bleeding disorder of any kind. Secondly, it results in transient bacteremia and patients may feel a lot of pain at times. Finally, tendons and nerves get damaged sometimes.
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