The Safe Guide to Debridement in the Challenging Clinical Setting Editorial Summary Debridement should be carried out as part of standard of care treatment. Safety and minimising of complications are essential when carrying out debridement in various clinical settings. Standard of care for debridement involves initial debridement to healthy tissue and any further weekly debridements as required. Debridement methods can be generalized into five broad categories, autolytic, enzymatic, biologic, mechanical, and sharp debridement.1-4 This article explores how wound debridement in anticoagulated patients can be achieved safely with use of a chitosan-based hemostatic agent.
Introduction
S
Dr Aliza Lee Clinical Research Investigator, Department of Veterans Affairs Salem VA, United States
22
everal wound care guidelines strongly recommend debridement be performed as part of the standard of care in the treatment of wounds.1-6 This recommendation has been in place through several iterations of wound care guidelines as wound debridement has been shown to reduce time to complete healing and increase the number of healed wounds.1,7 The recommended standard of care for debridement involves initial debridement followed by routine debridement to maintain a healthy wound base to promote wound resolution..2,3,8 Debridement methods can be generalized into five broad categories, autolytic, enzymatic, biologic, mechanical, and sharp debridement.1-4 While limited evidence exists to support the use of one debridement modality over another, ease of access, cost effectiveness, time efficiency in removal of nonviable and infected tissue, the ability to remove large amounts of tissue quickly and significantly reduce the number of microorganisms in the wound bed, make sharp debridement the preferred technique.1,3,7 Despite these recommendations, the use of sharp debridement may be limited due to patient factors, such as pain and insufficient arterial supply, and provider factors, such as limited experience, skill, scope of practice and licensing restrictions, resource access, and the concern that sharp debridement may cause the patient harm.1,3,4,6,8 One of these latter concerns that providers may have with sharp debridement is its relative contraindication in patients with bleeding disorders or those on anticoagulant therapy.3 Multiple modalities exist for achieving hemostasis following
Wound Masterclass - Vol 1 - December 2022
wound debridement. The most common modalities utilized in the outpatient, inpatient, and operating room setting include holding pressure, use of various topical hemostatic agents, chemical cautery with silver nitrate, and electrocautery.9,10 Disadvantages of these methods of achieving hemostasis include the time required to achieve hemostasis, the potential for tissue injury, expense, lack of access to necessary supplies, and the time required by the provider for appropriate follow up.3,11 Providers may choose to perform limited wound debridement or avoid it altogether in this patient population for these reasons, potentially contributing to delayed wound healing.8 Chitosan is a naturally occurring biocompatible, biodegradable, and non-toxic hemostatic agent with antimicrobial and antifungal properties that has been shown to promote wound healing.12 Presented here are the results of use of a chitosanbased hemostatic agent (OMNI-STAT®, Omnistat Medical Inc, New York, NY) following wound debridement in anticoagulated patients.
Methods A review of a series of patients on anticoagulant therapy with wounds requiring debridement, in the outpatient and operating room settings, in which a chitosan-based hemostatic agent was used to achieve hemostasis was performed. Sharp debridement was performed in all patients. After sharp debridement to bleeding tissue, chitosan-based granules and/ or impregnated gauze were applied to the wound following the protocol outlined in Table 1. The incidence of rebleed following sharp debridement was collected.
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