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 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.
Necrotic tissue often contains bacterial colonies that generate damaging proteases. Proteases break down vital components of extracellular matrix and affect the process of reepithelialization and formation of granulation tissue negatively. Thus, when wounds are debrided, the possibility of contamination is reduced and tissue destruction is reduced. Tissue destruction is reduced because of removal of cell debris.
Debriding of wounds is done using four main methods, that is, mechanical, surgical or sharp, enzymatic, and autolytic. Various factors are considered when choosing which method to use. Among the most significant factors are type, size, and position of wounds, time available for undertaking the process, moisture levels, the healthcare setting, and pain management. Additionally, the choice of method to use is also based on the overall health condition of a patient. Multiple methods are used in some cases.
Surgical or sharp debriding approach represents the fastest procedure for eliminating debris and necrotic tissues in wounds. The suitability of this method come in excess necrotic tissue is present in wounds, making it hard to determine their depth. Additionally, it is the most suitable procedure for removing bones and infected materials.
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 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.
Necrotic tissue often contains bacterial colonies that generate damaging proteases. Proteases break down vital components of extracellular matrix and affect the process of reepithelialization and formation of granulation tissue negatively. Thus, when wounds are debrided, the possibility of contamination is reduced and tissue destruction is reduced. Tissue destruction is reduced because of removal of cell debris.
Debriding of wounds is done using four main methods, that is, mechanical, surgical or sharp, enzymatic, and autolytic. Various factors are considered when choosing which method to use. Among the most significant factors are type, size, and position of wounds, time available for undertaking the process, moisture levels, the healthcare setting, and pain management. Additionally, the choice of method to use is also based on the overall health condition of a patient. Multiple methods are used in some cases.
Surgical or sharp debriding approach represents the fastest procedure for eliminating debris and necrotic tissues in wounds. The suitability of this method come in excess necrotic tissue is present in wounds, making it hard to determine their depth. Additionally, it is the most suitable procedure for removing bones and infected materials.
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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