EWMA
EWMA Document: Résumé
DEBRIDEMENT – An updated overview and clarification of the principle role of debridement Introduction The routine care of non-healing acute and chronic wounds often includes either the cleansing or debridement of the wound. Debridement induces the functional process of tissue repair and is a central medical intervention in the management of acute and chronic non-healing wounds. Many new debridement techniques have been introduced in recent years. These techniques primarily apply physical principles and forces to promote tissue repair from the acute inflammatory phase. Despite the central role of debridement in the field of wound healing, no document exists to summarize the different debridement techniques. With the “EWMA Document: Debridement - An updated overview and clarification of the principle role of debridement”, EWMA aims to provide an overview of the various options. This European Wound Management Association (EWMA) Document on Debridement comprises a general literature review and additional clinical expertise from the authors. The objective of this document is to provide an updated overview of debridement and recommend an overall clinical algorithm that defines the why, when, and how of debridement. Debridement refers to a process that removes adherent, dead, or contaminated tissue from a wound. Debridement is a separate process from the act of cleansing, which is defined as the removal of dirt (e.g., loose metabolic waste or foreign material) from a wound. We define debridement as the act of removing necrotic material, eschar, devitalised tissue, serocrusts, infected tissue, hyperkeratosis, slough, pus, haematomas, foreign bodies, debris, bone fragments, or any other type of bioburden from a wound to promote wound healing. Debridement is sometimes referred to as a form of wound bed preparation; however, from a global perspective, treatment of the wound edges and the peri-wound skin are as important as the wound EWMA Journal
2013 vol 13 no 1
bed for successful healing. This global perspective supports a definition of debridement that refers to the removal of bioburden from the wound bed as well as the liberation of wound edges and periwound skin. The purpose of this document is to show that this broader view of debridement opens new possibilities and perspectives within the field of wound healing. Debridement must be understood as a process that is used in conjunction with other treatment approaches when applying a global approach to wound healing. Debridement represents a central step in the management of wounds; therefore, this process can be applied to many types of wounds irrespective of their diagnoses and origins. A clear indication for debridement can be determined from the diagnosis of the tissue type, the type of bioburden that covers the wound bed, the state of the wound edges, and the state of the peri-wound skin. A definition of debridement that relates to the tissue type allows a clinician to define the appropriate time to apply the treatment as well as identify the most appropriate debridement method. Therefore, an appropriate diagnosis must first define the problem (e.g., necrosis, eschar, slough, source of infection) and define the exudate levels of the wound bed, which range from dry to wet. Many additional parameters influence both the decision to treat a wound with debridement and the technique that is chosen, including the amount of pain from the procedure, the patient’s environment, the patient’s choice, the patient’s age, the skill and resources of the caregiver, the patient’s quality of life, and regulations and guidelines.
Robert Strohal EWMA Council Member Other members of the group: Dissemond, J. O’Brien, J. Piaggesi, A. Rimdeika R. Young, T. Apelqvist, J ewma@ewma.org www.ewma.org The full document was published by the Journal of Wound Care in January 2013 (Strohal, R., Apelqvist, J., Dissemond, J. et al. EWMA Document: Debridement. J Wound Care. 2013; 22 (Suppl.1): S1–S52)
Mechanical debridement Mechanical wound debridement involves the use of dry gauze dressings, wet-to-dry gauze dressings, impregnated gauze/tulle dressings, or a monofilament fibre pad to remove non-viable tissue from the wound bed. 55