It is important to remove all forms of foreign matter and devitalized, dead, or contaminated tissue as part of the process of preparing beds of wounds. Clinicians use the term wound debridement to refer to the process by which necrotic and other materials are removed from wounds. Slough or necrotic materials are the terms used for all kinds of non-viable tissues found in wounds. Necrotic materials have a brownish or blacking color whereas slough is fibrinous yellow in color.
Necrotic tissue often accumulates in chronic wounds. It is made up of exudate, high levels of bacteria, non-viable tissue, and necrotic material. It tends to accumulate more in chronic wounds. Chronic wounds result from underlying and uncorrected pathogenic abnormalities like venous insufficiency and diabetes. Fully resolving these systemic problems is usually not possible. Thus, wound bed preparation becomes vital for facilitating closure of wounds.
Debridement is made useful and important by several diverse reasons. First, the clinician can assess the status of surrounding tissues and depth of wounds by eliminating devitalized tissue. Secondly, necrotic tissues usually hide any signs of infection in wounds. Also, the physical barrier that necrotic tissue presents supports development and growth of bacteria and also makes the healing process impossible.
Bacterial colonies contained in necrotic tissues create damaging proteases. Proteases negatively affect reepithelialization process and production of granulation tissues. As such, by debriding wounds the likelihood of contamination and destruction of tissue is reduced greatly. It is the elimination of cell debris that contribute to reduced tissue destruction.
There are four main methods of debriding wounds, that is, mechanical, autolytic, surgical or sharp, and enzymatic. Which method is chosen for debriding is made based on several factors. Some of the factors include the type, position, and size of wounds, pain management, time available for the process, moisture levels, and the healthcare setting. The overall condition of the patient is also considered a lot when choosing the methods to be used. Sometimes multiple methods may be employed at once.
Surgical or sharp debriding procedure is the fastest method to use in removing debris and necrotic tissues from wound beds. This approach is most suitable when the clinician cannot tell the depth of wounds due to presence of excess necrotic tissue. It is also the best option for removing infected materials and bones.
The surgical approach presents many benefits to patients. To begin with, damage of surrounding tissues is done to the minimal. Secondly, Repairing of wounds is made possible by slight bleeding that results. Wounds are repaired by cytokines and other inflammatory mediators released through bleeding. A thorough assessment of the patient must be done to ensure that they are suitable candidates for this procedure.
This approach also has shortcomings of its own. First, it should never be used on people whose immune system is compromised or those with bleeding disorders. Also, the procedure can be very painful in some situations and may cause transient bacteremia. Lastly, it is known to damage tendons and nerves in some cases.
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