Debridement: A Concise Guide Introduction
D
ebridement is the process of removing any devitalised tissue and bioburden from wounds. This includes necrotic material, eschar, infected tissue, slough, pus, haematoma, and debris. Caution should be exercised when debriding the wound in the community. Many patients are taking anticoagulants, and even the minimal amount of debridement can cause significant bleeding and blood loss1.
We have been taught that, in general, you should not undertake a procedure independently unless you are equipped to deal with the worst possible complication, forming the foundation for our clinical practice. However, it is vital to ensure that wound care practitioners are knowledgeable in the most recent advancements in debridement tools and techniques so patient care and clinical outcomes are improved2.
It is important to maintain meticulous documentation at each wound care visit to assess progress and standardised medical photography should also be utilised at each visit. The main features to document are: •
Location of the wound
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Site
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Size: considering all dimensions; length, width and depth
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Stage: what stage of wound healing is the wound currently in
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Vascular status of the wound
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Exudate level
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Wound bed
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Periwound
Ascertain the tissue type in the wound1 It is important that the method of debridement selected is the most effective for the patient and not limited by the skills of the practitioner. If the practitioner lacks the required skills they should seek support from within their own team, or consider further training if the situation is likely to occur frequently. Debridement is dependent on the clinical status of the wound, the general health of the patient and the skill and qualification of the healthcare personnel.
General Principles
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Viable tissue: this appears with a light pink to red hue and may be moist
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Epithelial tissue: this tissue is pale pink and may appear white, this normally signifies a healing wound
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Granulation tissue: often appears red and dotted in appearance. It is vital to identify overgranulation, as this requires early treatment
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Infected tissue: may be inflamed, red, swollen and have a border of erythema or cellulitis surrounding the periwound
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Necrotic tissue: is a result of cell death and may occur when there is concomitant bacteria, viruses, fungi or parasites present. It can also occur if there is a hypoxic wound environment present. Standard treatment generally involves surgical debridement, and antibiotics as per local protocol
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Eschar or slough: may be yellow, gray, black or brown in appearance. It may be soft or hard with a leathery appearance. Generally, dry, stable eschar should stay in place
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Exposed tendon, ligament or bone: this may appear yellow or off-white and is shiny unless dehydrated. Bone is hard and white unless it is
Assessment of the Wound
Miss Negin Shamsian Consultant Plastic & Reconstructive Surgeon (Locum) Chief Editor of Wound Masterclass London, United Kingdom
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Pick a suitable clinical area that has good lighting, access to all dressings and a sterile field to operate in. Ensure the patient is comfortable and provide an explanation to the patient. Assessment includes a full history of the patient, including duration of wound, exploring comorbidities and any other contributing factors that may highlight the potential aetiology to you.
Wound Masterclass - Vol 1 - June 2022