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GENERAL GUIDE
SLIDE WITH CROSSMARK LOGO CARRIES SIGNIFICANT ACADEMIC
& CLINICAL IMPORTANCE
YOU COULD ALSO PRE-ACCESS THIS ...
From the stump of the arm, the amputated leg, I undo the clotted lint,
remove the slough, wash the matter and blood. Back ...
Outline
• Definition
• Identifying materials to debride
• Reasons of debridement
• Option of Debridement
• Which one to ch...
Original
Definition
• Sir Pierre-Joseph Desault (1744 – 1795), Paris
• Surgical removal of necrotic material from open
wou...
My simplified definition of
debridement
[Remove] + [whatever not supposed to be there]
To remove
whatever not
supposed to be
there:
1. Foreign material
• Hair
• Composed thread
• Dead skin
2. Necrotic material...
SLOUGH
• Yellow
devitalized
tissue
• Stringy, thick,
adhere to
wound bed
ESCHAR
• Dry,
desiccate,
harden
• Brown or
black
...
Reasons of
Debridement
Presence of NM enhance bacterial colonization and infection
via activation of alternative pathway o...
Option of
debridement
1. Surgical & sharp
2. Mechanical
3. Autolytic, enzymatic, absorptive
dressing & honey
4. Larvae Deb...
Mechanism of action focus on debridement
Contraindication and limitation
1. Sharp debridement
i. MOA - cutting
ii. Indication - solid layer of necrotic tissue
iii. Contraindication – presumed inv...
2. Mechanical debridement (The Old Army)
Wet-to-dry Paraffin tulle Gauze Monofilament fibre pad
Background Commonest Compa...
3. Autolytic, enzymatic, absorptive dressing & honey
I. AUTOLYTIC
a. Hydrogels
b. Hydrocolloids
c. Hydrofibers
d. Multicom...
a) MOA - proteolytic enzymes – hydrolyse peptide bonds, MMPs
endocollagenases triple helix structure colagen (necrotic tis...
ORIGIN ENZYME SOURCE Example
ANIMAL Fibrinolysin Bovine plasma Elase, Fibrolan
Desoxyrbonuclease Bovine pancreas
Krill mul...
a) MOA - Dextranomer – 3D dextran porous
hydrophilic polymer. (1GM dextran to 4GM
fluid)
b) Indication - moderate to high ...
a) MOA - 30% glucose, 40% fructose, 5% sucrose, 20% water – osmotically draw
fluid for autolytic debridement. Antimicrobia...
4. Larvae
debridement
therapy
•
• Indication - exudatives chronic wound, loose or
biobag 10 – 15/ cm2 (biobag reduce yuks ...
Trifold Debridement System
a. Mouth – saliva secrete proteolytic enzyme and
collagenases, altering wound Ph (alkaline sali...
The
Debridement
Algorithm
• A suggested algorithm based on consensus of expert opinion
• To guide the choice of debridemen...
The Debridement Algorithm
MECHANICAL
•Fast
•No
expertise
needed
•Not
efficient
SHARP
•Fast
•Risk of
infection in
non-steri...
Conclusion
YES, compulsory to debride when you need to, according to The
Debridement Algorithm and NOT TO when the contrai...
Thank You
Dr Wan Zuraini Mahrawi
Wound Care Clinician
MSc Wound Healing & Tissue
Repair (UK), GCFM
mrs.wanzu@gmail.com
+60...
Role of Wound Debridement
Role of Wound Debridement
Role of Wound Debridement
Role of Wound Debridement
Role of Wound Debridement
Role of Wound Debridement
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Role of Wound Debridement

Role of wound debridement

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Role of Wound Debridement

  1. 1. GENERAL GUIDE SLIDE WITH CROSSMARK LOGO CARRIES SIGNIFICANT ACADEMIC & CLINICAL IMPORTANCE YOU COULD ALSO PRE-ACCESS THIS PRESENTATION ON SLIDESHARE.NET KEYWORDS: Wan Zuraini, Wound Debridement
  2. 2. From the stump of the arm, the amputated leg, I undo the clotted lint, remove the slough, wash the matter and blood. Back on his pillow the soldier bends with curv’d neck and side falling head. His eyes are closed, his face is pale, he dares not to look on the bloody stump, and has not yet look’d on it. The Wound Dresser, Leaves of Grass, Walt Whitman, 1819 - 1892
  3. 3. Outline • Definition • Identifying materials to debride • Reasons of debridement • Option of Debridement • Which one to choose? – The Debridement Algorithm • Conclusion
  4. 4. Original Definition • Sir Pierre-Joseph Desault (1744 – 1795), Paris • Surgical removal of necrotic material from open wound Dorland’s Medical Dictionary • “The removal of foreign material and devitalized or contaminated from or adjacent to a traumatized or infected lesion, until surrounding [and underlying in the case of cutaneous ulcer] healthy tissue is exposed”
  5. 5. My simplified definition of debridement [Remove] + [whatever not supposed to be there]
  6. 6. To remove whatever not supposed to be there: 1. Foreign material • Hair • Composed thread • Dead skin 2. Necrotic material on ulcer surface • Slough • Eschar • Crust 3. Others • Bone fragments • Hyperkeratosis • Callous
  7. 7. SLOUGH • Yellow devitalized tissue • Stringy, thick, adhere to wound bed ESCHAR • Dry, desiccate, harden • Brown or black • Devitalized protein and collagen • Cellular debris and solidified secretions CRUST • Secretions that have dried out • Does not contain dead tissue NECROTIC MATERIALS (nə-krō'sĭs) The death of cells or tissues from severe injury or disease, especially in a localized area of the body. Causes of necrosis include inadequate blood supply (as in infarcted tissue), bacterial infection, traumatic injury, and hyperthermia.) Debridement, Wound Healing & Ulcers of The Skin, Avi Shai by Springer page 135
  8. 8. Reasons of Debridement Presence of NM enhance bacterial colonization and infection via activation of alternative pathway of complement system – ongoing inflammation, tissue destruction, delay healing Foreign matter act as physical barrier, prevent normal wound contraction and re-epithelialization Decrease odor, excess moisture, risk of infection Other reasons – preparation for skin transplant and topical application of growth factor Improve quality of life
  9. 9. Option of debridement 1. Surgical & sharp 2. Mechanical 3. Autolytic, enzymatic, absorptive dressing & honey 4. Larvae Debridement Therapy 5. Technical Solutions EWMA Document: Debridement, 2013
  10. 10. Mechanism of action focus on debridement Contraindication and limitation
  11. 11. 1. Sharp debridement i. MOA - cutting ii. Indication - solid layer of necrotic tissue iii. Contraindication – presumed involvement deep structure – vessels, nerve, blood coagulation disorder iv. Limitation – spread of infection, pain, patients fear, requires special skills, risk of over-excision, specific area (neck, joint, face) v. Benefit – the fastest for WBP
  12. 12. 2. Mechanical debridement (The Old Army) Wet-to-dry Paraffin tulle Gauze Monofilament fibre pad Background Commonest Comparator in wound studies, limited information as debriding agent Mechanism of Action Moist gauze pad applied, tissue dries and hardened – pulled off Indication Short term therapy for infected necrotic wound Limitation Time consumed, cost, lack of concordance procedure, FB from gauze remnants, pain, increased risk of infection Pain, damage tissue upon removal, increased risk of infection, delay RE Pain, frequent dressing changes needed
  13. 13. 3. Autolytic, enzymatic, absorptive dressing & honey I. AUTOLYTIC a. Hydrogels b. Hydrocolloids c. Hydrofibers d. Multicomponent dressings hydration response technology (HRT), iodine pair, alginogel Dual MOA: 1. Donate water, absorb exudates 2. EPE release – collagenase, elastase, myeloperoxidase, hydroxylase, lysozyme, phagocyte activation Indication - remove fibrin coatings, eschar, slough. Selection depends on exudates level Contraindication – presumed involvement deep structure – vessels, nerve, blood coagulation disorder, sensitive to propylene glycol, deep cavity, bleeding wounds, necrotic digit Occlusive + high exudates > p.aeroginosa Limitation – HG for low exudates, control minimal infection, slow action, maceration, pain with iodine, cost Easiest and safest Take note: 1. HG – coat 2mm, sheets 2 cm peri 2. Highly absorptive – 3mm 3. Cadexomer iodine – 150mg/wk, no longer 3mths. CI in iodine sensitivity – HTX, Hashimoto, thyroiditis. Tissue reaction HK Cooling effect HG sheets PMMD – glycerin / starch
  14. 14. a) MOA - proteolytic enzymes – hydrolyse peptide bonds, MMPs endocollagenases triple helix structure colagen (necrotic tissue in ECM contain type IV collagen, glycoproteins, proteoglycans) b) Indication - mechanical CI, bleeding disorder c) Contraindication – dry wound d) Limitation – periwound irritation, fever and leukocytosis (streptodornase) absorption of purine / pyrimidines, costly e) Benefit – applied 2 – 3 mm thickness in moist wound, easy, safe ii. Enzymatic
  15. 15. ORIGIN ENZYME SOURCE Example ANIMAL Fibrinolysin Bovine plasma Elase, Fibrolan Desoxyrbonuclease Bovine pancreas Krill multienzyme Antarctc krill Collagenase Paralithodes camtshatica Catalase Equine liver PLANT Papain Carica papaya Accuzyme Bromelain enzyme complex Pineapple BACTERIA Collagenase Clostridium hystiliticum Streptokinase Streptococcus hemolyticus Varidase Streptodomase Streptococcus hemolyticus Varidase Sutilain Bacilus subtilis PROTEOLYTIC ENZYME FOR WOUND TREATMENT
  16. 16. a) MOA - Dextranomer – 3D dextran porous hydrophilic polymer. (1GM dextran to 4GM fluid) b) Indication - moderate to high exudates c) Contraindication – mucosal surface, bottleneck wound d) Limitation – pain, erythema, blister e) Benefit – easy to handle iii. ABSORPTIVE
  17. 17. a) MOA - 30% glucose, 40% fructose, 5% sucrose, 20% water – osmotically draw fluid for autolytic debridement. Antimicrobial when osmotic dehydration – low pH 3 – 5 and release of hydrogen peroxide and methylglyoxal. Anti-inflammatory stimulate immune response – decrease ROS and TNF release b) Indication - low to moderate exudates c) Contraindication – dry, necrotic wound, sensitive to bee venom d) Limitation – natural honey contaminated with pesticides, clostridia spores, allergic reaction as in pollen. Pain due to acidity e) Benefit – antimicrobial, deodorize agent 20ml of honey on 10cm2 dressing IV. HONEY
  18. 18. 4. Larvae debridement therapy • • Indication - exudatives chronic wound, loose or biobag 10 – 15/ cm2 (biobag reduce yuks factor). Loose larvae are quicker than biobag but time of healing same • Contraindication – vermiphobia, not to use on mucosal surface, allergy to fly larvae, yeast, soy-bean, patients with decrease perfusion, exposed vessels • Limitation – not to put on pressure area, too much exudates, suffocated larvae, cause pain • Benefit – cost effective, reduce odor, • Hydrocolloid strip or zinc paste to protect periwound • Allantoin
  19. 19. Trifold Debridement System a. Mouth – saliva secrete proteolytic enzyme and collagenases, altering wound Ph (alkaline saliva) b. Hollow – ingest necrotic tissue and neutralizing bacteria in their gut. Prevent contamination via peritrophic membrane (acidic gut) c. Body – movement increase exudate production and irrigation, wider distribution of fibroblast within wound bed MECHANISM OF ACTION – LUCILIA SERICATA
  20. 20. The Debridement Algorithm • A suggested algorithm based on consensus of expert opinion • To guide the choice of debridement technique • Start with – time consumed, then – technology available • Consider following parameters that may influence the decision- Pain Patients environment Patients' choice Age Comorbid Quality of life Skill of caregiver Resources of caregiver EWMA Document: Debridement, 2013
  21. 21. The Debridement Algorithm MECHANICAL •Fast •No expertise needed •Not efficient SHARP •Fast •Risk of infection in non-sterile environme nt NO LARVAE •Reduce pain and odor NO AT / ENZYMATC •Safest NO JET / USOUND •Equipment not generally available NO SURGICAL •Required skill LESS TIME CONSUMING MORE TIME CONSUMING EWMA Document: Debridement, 2013
  22. 22. Conclusion YES, compulsory to debride when you need to, according to The Debridement Algorithm and NOT TO when the contraindication and limitation is there.
  23. 23. Thank You Dr Wan Zuraini Mahrawi Wound Care Clinician MSc Wound Healing & Tissue Repair (UK), GCFM mrs.wanzu@gmail.com +6011-33515410

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