wound debriderment.pptx

wound debridement

1. WOUND DEBRIDERMENT, HOW FAR WE KNOW IT? DR. KHADIJAH NORDIN Coordinator Unit Penjagaan Luka HEBHK CCWC(Malaysia) PGWM (on going)

2. Wound debridement  a procedure to remove dead, devitalized, or contaminated tissue as well as necrotic tissue , eschar, slough, pus, hematomas, hyperkeratosis, foreign bodies, debries , biofilm, bone fragments, or another bioburden from a wound bed.

3. Wound cleansing “The use of fluids to remove loosely adherent debris and necrotic tissue from the wound surface.”

4. BIOFILM “a structured community of bacterial cells enclosed in a self-produced polymeric matrix (extracellular polymeric substance-EPS) and adherent to an inert (non-living thing) or living surface” Has 3 functional layer present in most chronic wounds and are likely to be located both on the surface and in deeper wound layers, but may not be present uniformly across or within the wound

5. Aim Of Debridement

6. Ultrasonic Assisted Debridement Surgical Debridement METHOD OF WOUND DEBRIDEMENT Enzymatic Debridement Autolytic Debridement Biological Debridement Mechanical Debridement Hydrostatic Debridement Combination Debridement

7. Mechanical Debridement Process of debriding by using materials (gauze, gamgee Bactigrass , paraffin gauze, debrisoft , debrisoft lolly) to moisten up the dry necrotic wound (wet to dry method) Not affective on thick eschar wound and may even wipe out healthy wound tissues. Wet gauze to dry necrotic tissues

8. Autolytic Debridement Usage of hydrogels to soften the necrotic tissues. Rehydrates tissues and necrotic tissue/eschar Hydrogels provide moist wound bed Example : hyzo gel, intrasite gel, cavida gel, prontosan gel, dermacyn gel, hydrocyn gel

9. Enzymatic Debridement Use of topically applied enzyme (proteolytic) agents to break the non-viable tissue Faster effect than autolytic However, it will not destroy good tissues, granulation tissues Using enzymes to break down proteins that strengthen the bacterial chain wall Example: HONEY dressing (Manuka)

10. Surgical Debridement When: when the infection involve deep tissues with clear demarcation between viable and non viable tissues. Instruments : Surgical scalpel blade , disposable blade , curettege , rongeur forceps. Benefit : faster effect and low cost. Contraindication: may cause excessice removal of tissues

11. Biological Debridement Maggot therapy Leech therapy

12. From Lucillia Cuprina and Lucilia Sericata flies Harvested and sterilized Will only eat dead tissues/slough Not suitable for deep cavity wound / near organ wound Maggot therapy

13. Leech therapy The most interesting is to improve circulation in the legs. Ideal for patients with severe peripheral arterial disease who cannot be improved with revascularization Leeches to relieve venous congestions following reattachment or transplantation surgery of fingers, toes, ears, penis, and other skin-flaps

14. Hydrostatic Debridement Using a high power hydrostatic debrider . Usage of advancement technology such as versajet , ultrasonic debridement machine to remove dead tissues. Using high water jet pressure Can either gently removed or excessively removed. May/may not exacerbate pain.

15. UAW is a lesser-known debridement method that uses low-frequency ultrasound waves. There is evidence to show that the three clinical effects of atraumatic selective tissue debridement, wound stimulatory effects, and antibacterial activity facilitate early healing of wounds, reducing the cost to the healthcare system and improving the patient’s quality of life effective removal of devitalized tissue preservation of healthy tissue creation of a clean, viable wound bed disrupting of biofilms prevention of biofilm reformation Ultrasonic Assisted Debridement (UAW)

16. The ultrasonic vibrations of the UAW instrument generate cavitation bubbles in the irrigation solution. Those bubbles implode due to pressure changes and generate strong sonic shock waves, so-called microjets. Devitalized tissue and foreign bodies are removed from the wound bed and biofilms are disrupted. Healthy tissue is hardly affected due to its higher elastin content, so that the healing process can proceed rapidly.

17. Combination Debridement