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.
Chronic wounds will often have a buildup of necrotic tissue. The necrotic tissue is composed of necrotic material, high bacterial levels, exudate, and non-viable tissue. As opposed to other forms of wounds, chronic wounds tend to accumulate necrotic tissue more. Chronic wounds result because of diabetes, venous insufficiency and other underlying and uncorrected pathogenic abnormalities. Often, these abnormalities are insolvable. Thus, preparing wound beds so as to facilitate closure of wounds become necessary.
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 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.
The surgical procedure has shortcomings of its own. To begin with, it should never be used on individual who suffer from bleeding disorders and those whose immune systems are compromised. Secondly, it may cause transient bacteremia and some patients experience excess pain during the process. Lastly, there may be damage done to nerves, muscles, and tendons.
Chronic wounds will often have a buildup of necrotic tissue. The necrotic tissue is composed of necrotic material, high bacterial levels, exudate, and non-viable tissue. As opposed to other forms of wounds, chronic wounds tend to accumulate necrotic tissue more. Chronic wounds result because of diabetes, venous insufficiency and other underlying and uncorrected pathogenic abnormalities. Often, these abnormalities are insolvable. Thus, preparing wound beds so as to facilitate closure of wounds become necessary.
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 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.
The surgical procedure has shortcomings of its own. To begin with, it should never be used on individual who suffer from bleeding disorders and those whose immune systems are compromised. Secondly, it may cause transient bacteremia and some patients experience excess pain during the process. Lastly, there may be damage done to nerves, muscles, and tendons.
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