Define debridement.
Removal of devitalized tissue and foreign matter from a wound
Which type of debridement removes healthy tissue and necrotic tissue?
Non-selective
Which type of debridement removes ONLY necrotic tissue?
Selective
What are the 4 main types of debridement?
Sharp, Autolytic, Enzymatic & Mechanical
What are the general indications for debridement?
Necrotic Tissue
Foreign Material
Debris
Possibly Blisters & Calluses
What are the general contraindications for debridement?
-Red, granular wounds
-"Stable" heel ulcers with eschar that don't have signs of infection
-Wounds that require surgical debridement
What are examples of selective debridement methods?
Sharp
Autolytic
Enzymatic
Biologic
What are some examples of non-selective debridement methods?
Mechanical
-Wet to dry
-Scrubing
-Wound cleansers
-Would irrigation with water pik/soaked gauze
-Pulsed lavage
-Whirlpool
Surgical
What is the fastest most aggressive form of debridement?
Sharp
What are the indications for sharp debridement?
Necrosis
Callus
Advancing cellulitis
Sepsis
Eschar
Yellow Slough
What are the contraindications for sharp debridement?
*When area cannot be adequately visualized
*Material to be debrided is unidentified
*Lack of clinician competency
*Infected ischemic ulcers with low ABIs
*Patients who are:
-immunosuppressed
-thrombocytopenic
-who are taking anticoagulants
*Wound closure
What type of sharp debridement removes loosely adherent tissue with the use of forceps and scissors and is performed by PTs and PTAs?
Serial Instrumental Debridement
What type of sharp debridement can only be performed by PTs and involves the use of a scalpel?
Selective Sharp Debridement
When using a scalpel and scissors, you want to hold them ____________ to the wound surface.
parallel
What is the least invasive and least painful method of debridement?
Autolytic
Does autolytic debridement allow for frequent visualization of wound?
No
What is autolytic debridement?
Use of body's endogenous enzymes to digest necrotic tissue with a moisture-retentive dressing
Do you want to use autolytic debridement on infected wounds?
No
Which debridement procedures requires crosshatching of the eschar?
Autolytic & Enzymatic
What do you want to put on in order to protect the periwound area before autolytic debridement?
A skin sealant
Which types of debridement require a physician's prescription?
Sharp and Enzymatic
The use of a topical exogenous enzyme such as Santyl to remove devitalized tissue is what type of debridement?
Enzymatic
Can enzymatic debridement be used on infected wounds with necrotic tissue?
Yes (infected and uninfected wounds)
What are the contraindications to enzymatic debridement?
*Wounds with exposed deep tissue
*Facial burns
*Calluses
*Wounds free of necrotic tissue
*Cannot be combined with autolytic debridement
*Can be inactivated by heavy metal ions & acidic solutions
What is an example of biologic debridement?
Maggots
What is mechanical debridement?
The use of force to remove devitalized tissue, foreign material, and debris from a wound
When is wet-to-dry indicated?
For wounds with 100% devitalized wound bed
Scrubbing is used for what kind of wounds?
Superficial
When is surgical debridement indicated?
*Ascending cellulitis
*Osteomyelitis
*Extensive Necrotic Wounds
*Undermining
*Necrotic tissue near vital organs/structures