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 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.
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.
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.
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.
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 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.
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.
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.
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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