Debridement in surgical nursing / surgery.pptx

This document contains information on debridement, which is the removal of dead or necrotic tissues from a wound to help the wound to heal. It also contains types of debridements and explanations.

1. Debridement Debridement is the removal of dead (necrotic) or infected skin tissue to help a wound heal. It’s also done to remove foreign material from tissue. Debridement is recognized as a major component of wound management to prepare the wound bed for reepithelialization . The procedure is essential for wounds that aren’t getting better. Usually, these wounds are trapped in the first stage of healing. When bad tissue is removed, the wound can restart the healing process. Wound debridement can: H elp healthy tissue grow Minimize scaring R educe complications of infections

2. Debridement types Biological debridement Biological debridement uses sterile maggots from the species  Lucilia sericata , the common green bottle fly. The process is also called larval therapy, maggot debridement therapy, and biosurgery. The maggots help wound healing by eating old tissue. They also control infection by releasing antibacterial substances and eating harmful bacteria. The maggots are placed on the wound or in a mesh bag, which is kept in place with dressing. They’re left for 24 to 72 hours and replaced twice a week. Biological debridement is best for wounds that are large or infected by antibiotic-resistant strains of bacteria, like MRSA. It’s also used if you can’t have surgery due to medical conditions.

3. Enzymatic debridement Enzymatic debridement, or chemical debridement, uses an ointment or gel with enzymes that soften unhealthy tissue. The enzymes may come from an animal, plant, or bacteria. The medication is applied once or twice a day. The wound is covered with a dressing, which is changed regularly. The dressing will take away dead tissue when it’s removed. Enzymatic debridement is ideal if you have bleeding problems or a high risk for surgery complications. It’s not recommended for large and severely infected wounds.

4. Autolytic debridement Autolytic debridement uses your body’s enzymes and natural fluids to soften bad tissue. This is done with a moisture-retaining dressing that’s typically changed once a day. When moisture accumulates, old tissue swells up and separates from the wound. Autolytic debridement is best for noninfected wounds and pressure sores. It is a highly selective process whereby only necrotic tissue will be affected in the debridement. It is indicated for noninfected wounds. It may also be used as adjunctive therapy in infected wounds. It can be used with other debridement techniques such as mechanical debridement in the case of infected wounds.

5. Mechanical debridement Mechanical debridement is the most common type of wound debridement. Mechanical debridement is a nonselective type of debridement, meaning that it will remove both devitalized tissue and debris as well as viable tissue. Types of mechanical debridement include: Hydrotherapy.  This method uses running water to wash away old tissue. It might involve a whirlpool bath, shower treatment, or syringe and catheter tube. Wet-to-dry dressing.  Wet gauze is applied to the wound. After it dries and sticks to the wound, it’s physically removed, which takes away dead tissue. Monofilament debridement pads ( Debrisoft ). Debrisoft is a single use, soft, polyester fibre pad which is wiped across the wound in either circular or vertical motions (depending on tissue type), dead cells and wound debris are caught within the fibres and removed from the wound bed. The advantages of debridement using Debrisoft is that it is easy to perform, requires little training, it is a fast effective method which causes no damage to the healthy underlying or surrounding tissue Mechanical debridement is appropriate for noninfected and infected wounds.

6. Surgical Debridement with Sharp Instruments This is a type of debridement where devitalized tissue (slough, necrotic, or eschar) in the presence of underlying infection is removed using sharp instruments such as a scalpel, Metzenbaum, curettes, among others. This can be done bedside, in the office or wound care center, or in the operating room depending on the adequacy of anesthesia and the ability to control perioperative complications like bleeding. The healthcare professional should be skilled and trained and qualified and licensed to provide surgical treatment. Sharp-instrument debridement can be combined with all the other methods of debridement during the perioperative period. Disadvantages of surgical debridement include adverse events from the debridement itself, for example, bleeding and possible general complications from the anesthesia.