Chronic wounds are at times quite difficult to manage especially if there is a lot of dead tissue. Wound debridement is the process through which this dead tissue is removed. In some cases, there may be a need to remove foreign materials such as wood, glass and metal. The number of sessions varies depending on the amount of tissue to be removed. We will look at the benefits of this procedure and the methods that can be used.
There are a number of reasons as to why a wound needs to be debrided. The first of them is the fact that healing is expedited. Dead tissue tends to trap bacterial organisms and its removal reduces the number of organisms that one has to deal with. Dead tissue also hides pockets of pus that is associated with odor and the onset of new infections. Removal of this tissue gets rid of the odor and provides an opportunity for newer tissues to grow.
Methods used for this exercise are greatly variable. Examples include surgical, autolytic, enzymatic, mechanical and biosurgery debridement. Each of these may be used singly or in combination. Combinations usually yield the best results. The choice is determined by factors. These include, among others, the type of wound involved, the level of pain anticipated and the risk of infection.
The surgical procedure is one of the oldest techniques that have been used. It is also the fastest. The main side effects include pain, bleeding and damage to viable tissues among others. It stimulates the release of cytokines and growth factors which in turn result into a faster healing process. Local anesthetic agents (such as lignocaine) are usually administered to minimize the pain. Application of pressure and dressing usually controls the bleeding.
Autolytic debridement is facilitated by enzymes that are released by body cells. These enzymes selectively digest the dead and decaying tissues but usually spare normal cells and tissues. Examples include enzymes such as collagenase, myeloperoxidase, acid hydrolase and elastase among others. This process is among the slowest and may need occlusive dressing to enhance the process of healing.
Chemical or enzymatic debridement is done in a manner that is similar to autolysis. The main difference is that the chemicals used in the enzymatic process are artificially prepared. The procedure is usually done to complement surgical dead tissue removal. Exogenous enzymes that are used in this process can be obtained commercially and include streptokinase, collagenase, trypsin and paparin among others. The most effective option among these is the collagenase-based approach.
Biosurgery (also termed myiasis) is a biological debridement method that uses fly maggots. The maggots are bred in a sterile environment before being introduced to the wound. They selectively destroy the dead tissue and spare the normal areas. Other mechanisms are believed to be involved as well. For instance, they are said to kill and ingest bacteria as well by producing a number of enzymes. They also increase the PH of the area as well as oxygenation both of which favor healing.
Debridement of wounds is an important process in the management of chronic skin infections. The decision to have the procedure is usually made by the doctor opening on a number of factors such as the location, the size and the severity of infection among others. These factors also determine the type of procedure that will be chosen and the frequency at which debridement will be done.
There are a number of reasons as to why a wound needs to be debrided. The first of them is the fact that healing is expedited. Dead tissue tends to trap bacterial organisms and its removal reduces the number of organisms that one has to deal with. Dead tissue also hides pockets of pus that is associated with odor and the onset of new infections. Removal of this tissue gets rid of the odor and provides an opportunity for newer tissues to grow.
Methods used for this exercise are greatly variable. Examples include surgical, autolytic, enzymatic, mechanical and biosurgery debridement. Each of these may be used singly or in combination. Combinations usually yield the best results. The choice is determined by factors. These include, among others, the type of wound involved, the level of pain anticipated and the risk of infection.
The surgical procedure is one of the oldest techniques that have been used. It is also the fastest. The main side effects include pain, bleeding and damage to viable tissues among others. It stimulates the release of cytokines and growth factors which in turn result into a faster healing process. Local anesthetic agents (such as lignocaine) are usually administered to minimize the pain. Application of pressure and dressing usually controls the bleeding.
Autolytic debridement is facilitated by enzymes that are released by body cells. These enzymes selectively digest the dead and decaying tissues but usually spare normal cells and tissues. Examples include enzymes such as collagenase, myeloperoxidase, acid hydrolase and elastase among others. This process is among the slowest and may need occlusive dressing to enhance the process of healing.
Chemical or enzymatic debridement is done in a manner that is similar to autolysis. The main difference is that the chemicals used in the enzymatic process are artificially prepared. The procedure is usually done to complement surgical dead tissue removal. Exogenous enzymes that are used in this process can be obtained commercially and include streptokinase, collagenase, trypsin and paparin among others. The most effective option among these is the collagenase-based approach.
Biosurgery (also termed myiasis) is a biological debridement method that uses fly maggots. The maggots are bred in a sterile environment before being introduced to the wound. They selectively destroy the dead tissue and spare the normal areas. Other mechanisms are believed to be involved as well. For instance, they are said to kill and ingest bacteria as well by producing a number of enzymes. They also increase the PH of the area as well as oxygenation both of which favor healing.
Debridement of wounds is an important process in the management of chronic skin infections. The decision to have the procedure is usually made by the doctor opening on a number of factors such as the location, the size and the severity of infection among others. These factors also determine the type of procedure that will be chosen and the frequency at which debridement will be done.
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