Wound Debridement Kairy
Transcript of Wound Debridement Kairy
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WOUND DEBRIDEMENT
DR. KHAIRI HASSAN
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Definition Removal of foreign material and dead
or contaminated tissue from and
around a traumatic or infected lesionin order to expose healthy tissue andoptimize healing.
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PHASES Initial Phase:
Removing burden of necrotic tissue
(Surgery; Maggots, etc.) Maintenance Phase
Keep the wound free of necrotic
tissue (Dressing, enzymes, etc.)
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DEBRIDEMENTWhat?
Why?When?
Who?
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WHAT?
Debris, slough or necrotic tissues:
Devitalized, necrotic or contaminated
tissue consisting of fibrinous material,nucleoproteins, collagen and elastin
This material interferes with thenormal healing process, because itprovides a medium for bacterialgrowth and it acts as physical barrierto repair.
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METHODS (HOW
?) Surgical and sharp debridement
Mechanical
- Hydrotherapy- Wet-to-dry dressing
Autolytic
Enzymatic
Biological such as Maggot therapy
Chemical
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SELECTING THE
APPROPRIATE METHOD Type of wound (depth, tissue
involved)
Type of necrosis (dry, wet, infected) Type of patient
Skill of clinician
Resources Care setting
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ADVANTAGES OF DEBRIDEMENT Efficient debridement is essential in
treating all wounds
Allow healthy granulation tissue toform
Reduces wound contamination andfurther tissue destruction
Reduces dead spaces that harbourbacterial growth
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SURGICAL/SHARP DEBRIDEMENT Advantages:
- highly selective
- rapid result
- simple
- universal usable
Disadvantages:
- invasive, damaging
- skilled personnel- risk of anaesthesia
- maybe expensive
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MAGGOT THERAPY
EXPECTED MODE OF ACTION
Eating necrotic tissueDebridementIngested bacteria are killed in thegut
Kills bacteria
Production of Ammoniap o pH pinhibits bacterial growth
Environmental
Secretion of chemical with anti-microbial activities
Antibiotic effect
Combined effect of earlier effects.Direct stimulatory effect
o Wound healing
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INDICATION All types of problem wounds; surgical
or other types of debridement are
difficult, risky or not available Other conditions e.g. osteomyelitis,
burns, abscesses, necrotising fascitis
Preparation for grafting
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MAGGOT THERAPYContraindications:
1. Absolute
Fistula, wound, connected to bodycavity, rapid advancing tissuenecrosis
2. RelativeExposed vessel, bleeding tendency,difficult dissolving tissue
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ADVANTAGES/DISADVANTAGES
Disadvantages
-Theethicalaspect
-Requiressomeskill
-Maybeexpensive
-Cancausepain
-Notavailableinallplaces
Advantages
-Effective
-Selective
-Simple
-Rapid
-Universalusable
-Killsbacteria
-Mayo healing
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AUTOLYTIC DEBRIDEMENT Definition:
The process by which the wound bed
utilizes phagocytic cells andproteolytic enzymes to removedevitalized tissue.
This process to can be promoted andenhanced by maintaining a moistwound environment
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AUTOLYTIC DEBRIDEMENT Use of moisture-retentive dressing
Slower process than other methods
Progress should be observed within72-96 hours
Wound will increase in length, width,depth
Attention to peri-wound maceration Collection of wound exudate and
accompanying odour as indicative ofan infection
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ENZYMATIC DEBRIDEMENT Definition:
The use of topically applied chemical
agents to stimulate the breakdown ofnecrotic tissue.
Common topical agents:
- collagenase- fibrinogen/deoxyribonuclease
- papain/urea
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MODE OF ACTION Directly digesting the components of
slough (fibrin, bacteria, leukocytes,
cell debris, serous exudate and DNA) Dissolving the collagen anchors that
secure the avascular tissue to theunderlying wound bed
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ENZYMATIC DEBRIDEMENTAdvantages/Disadvantages Uses topical applications/exogenous
enzymes to the wound surface
Useful in removing eschar from largewounds
Excess exudate may be produced by thisagents
Ointments may be used to protect peri-wound intact skin
Enzymes and reimbursement implications
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CONCLUSIONRemoval of foreign material and dead or
contaminated tissue from a traumatic
or infected lesion is essential fortreatment and outcome of problemwounds.
The effectiveness of wound debridement
depends on the knowledge, skill andability of the individual practitionerand the cooperation of the patient.
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THANK YOU.