Sunday, June 10, 2018

A Few Notes Concerning Wound Debridement

By Michael White


When the protective barrier of the skin is breached, a wound is formed. Whether the wound remains clean or becomes infected depends on a number of factors. Surgical wounds are usually clean unless certain systems are directly involved. These systems are the gastrointestinal, genitourinary and respiratory. When this happens, the wound is said to be contaminated. Introduction of foreign bodies and complication with intense foul smelling pus qualifies a wound to be dirty. This is when wound debridement comes in handy.

A dirty wound is one that is seen when a foreign substance has been introduced into the body. This happens, for example, when someone gets pricked say by a small piece of wood which gets stuck in tissues. It may also result when one gets shot and the bullet remains lodged in the body. In other situations, dirty wounds may be created in hospital if healthcare providers are not diligent enough when caring for clean wounds. Regardless of which foreign body is involved, the end result is infection if the object is not removed in time.

Debridement is necessary for dead tissue that is too extensive and has been complicated by production of foul smelling pus. Often this comes about when issues are not addressed with the urgency they deserve. Firstly, the victim of injury should be proactive in dressing the injured area with clean clothing to minimize exposure to microbes even as they seek definitive care in hospital. In the hospital, the area will be properly dressed and prophylactic antibiotics given.

Exposure of body cells to the external atmosphere puts them at risk of invasion by harmful microorganisms. Fortunately, the human body has its own immune system that helps in fighting off infection. This is composed of white blood cells which are recruited to the site of infection immediately the bacteria start multiplying. If the infection is too extensive, the immune system may become overwhelmed and the end result is formation of pus cells and accumulation of dead smelly tissues.

Debridement can be done manually or by use of a chemical. During the manual procedure, the surgeon scraps off dead tissues using special surgical instruments. The patient is put under general or local anaesthesia depending on how much tissue has decayed. In the chemical form of debridement, special chemicals are used to break down the unwanted tissues and lift them off.

Occasionally, maggots can be utilized to manage certain wounds. They work by consuming the bacteria deposited in a given area and prevent its spread to the rest of the body. The only downside to this is that it may not be pleasant site to behold.

The area is usually dressed after every debridement session to prevent further exposure to microbes and to provide some time for it to heal. Grafting should be considered for wounds that are extremely extensive. This may mean that a plastic and reconstructive surgeon be incorporated into the management team.

It is important that sterile measures are observed when to prevent further spread of infection to the rest of the body. Patients with a low immunity level are disadvantaged because their wounds tend to take longer to heal. Such include persons with diabetes and cancer.




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