Dead, contaminated or devitalized tissue and foreign matter need to be removed from wounds as part of the first steps in wound bed preparation. The removal of such matter is what is called wound debridement. The term slough or necrotic tissues is used to refer to non-viable tissue in wounds. Necrotic tissue is often colored brown or black. If the tissue is yellow in color and fibrinous, the name slough is used.
There is often an accumulation of necrotic tissue in chronic wounds. This tissue is comprised of exudate, non-viable tissue, necrotic material, and high bacterial levels. The tendency of necrotic tissue to accumulate is higher in chronic wounds. The cause of chronic wounds is venous insufficiency and diabetes among other underlying and uncorrected pathogenic abnormalities. Resolving these systemic issues in full is normally impossible. As such, it becomes important to prepare the bed of the wound in order to facilitate closure of the wounds.
Debridement is important due to a number of reasons. First, devitalized tissue need to be removed to allow the clinician to be able to assess how deep wounds are and to know what condition surrounding tissues are in. The second reason is that necrotic tissues often mask symptoms of local infections in the wound. Finally, when necrotic tissue is present, it serves as a physical barrier to the healing process and also significantly supports growth of bacteria.
Bacterial colonies are often contained in necrotic tissue and they produce damaging proteases. Proteases have a negative effect on reepithelialization process and the production of granulation tissue. As such, debriding wounds reduces the probability of contamination and tissue destruction. The cause for a reduction in tissue destruction is the elimination of cell debris.
The methods of debriding of wounds can be classified into four main categories, that is, mechanical, enzymatic, autolytic, and surgical or sharp. Which method is used depends on various factors. These factors include size, position, and type of wounds, the healthcare setting, pain management, amount of time present for performing the process, and moisture levels. In addition, the overall health of the individual also plays a role in the choice of method. More than one procedure can be used in some cases.
Sharp or surgical debriding method represents the fastest option for removing necrotic tissue and debris from beds of wounds. This approach is at times adopted when extensive amounts of necrotic tissue are in wounds making it hard to judge how deep they go. The surgical method is also useful when infected material and bone have to be removed.
There are several advantages associated with the use of the surgical approach. First, it results in the least level of damage to tissue surrounding the wounds. Secondly, the procedure may lead to minor bleeding which releases cytokines and other inflammatory mediators which help in the process of repairing wounds. The patient has to be assessed first for suitability of this method to them before it can be used.
There are many shortcomings associated with this approach too. First, it can only be used on individuals with uncompromised immune systems and no bleeding disorder of any kind. Secondly, it results in transient bacteremia and patients may feel a lot of pain at times. Finally, tendons and nerves get damaged sometimes.
There is often an accumulation of necrotic tissue in chronic wounds. This tissue is comprised of exudate, non-viable tissue, necrotic material, and high bacterial levels. The tendency of necrotic tissue to accumulate is higher in chronic wounds. The cause of chronic wounds is venous insufficiency and diabetes among other underlying and uncorrected pathogenic abnormalities. Resolving these systemic issues in full is normally impossible. As such, it becomes important to prepare the bed of the wound in order to facilitate closure of the wounds.
Debridement is important due to a number of reasons. First, devitalized tissue need to be removed to allow the clinician to be able to assess how deep wounds are and to know what condition surrounding tissues are in. The second reason is that necrotic tissues often mask symptoms of local infections in the wound. Finally, when necrotic tissue is present, it serves as a physical barrier to the healing process and also significantly supports growth of bacteria.
Bacterial colonies are often contained in necrotic tissue and they produce damaging proteases. Proteases have a negative effect on reepithelialization process and the production of granulation tissue. As such, debriding wounds reduces the probability of contamination and tissue destruction. The cause for a reduction in tissue destruction is the elimination of cell debris.
The methods of debriding of wounds can be classified into four main categories, that is, mechanical, enzymatic, autolytic, and surgical or sharp. Which method is used depends on various factors. These factors include size, position, and type of wounds, the healthcare setting, pain management, amount of time present for performing the process, and moisture levels. In addition, the overall health of the individual also plays a role in the choice of method. More than one procedure can be used in some cases.
Sharp or surgical debriding method represents the fastest option for removing necrotic tissue and debris from beds of wounds. This approach is at times adopted when extensive amounts of necrotic tissue are in wounds making it hard to judge how deep they go. The surgical method is also useful when infected material and bone have to be removed.
There are several advantages associated with the use of the surgical approach. First, it results in the least level of damage to tissue surrounding the wounds. Secondly, the procedure may lead to minor bleeding which releases cytokines and other inflammatory mediators which help in the process of repairing wounds. The patient has to be assessed first for suitability of this method to them before it can be used.
There are many shortcomings associated with this approach too. First, it can only be used on individuals with uncompromised immune systems and no bleeding disorder of any kind. Secondly, it results in transient bacteremia and patients may feel a lot of pain at times. Finally, tendons and nerves get damaged sometimes.
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