Wound Care

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Chapter 38 Wound Care

OVERVIEW.

Wound care may incorporate debridement techniques. Debridement is the procedure of removing devitalized tissue (and foreign matter) from a wound. Moist devitalized tissue supports the growth of pathological organisms, initiates an inflammatory response, and retards wound healing. The removal of devitalized tissue is considered necessary for wounds to heal.¹

In this section, debridement concerns for autolytic, enzymatic, mechanical (wet-to-dry gauze dressings, wound irrigation, whirlpool, dextromoners), and sharp techniques are reviewed. The sources included one governmental/agency, three physical therapy, and one nursing. Wound cleaning solvents and dressing issues are also briefly addressed.

CONTRAINDICATIONS AND PRECAUTIONS

DEBRIDEMENT

Autolytic Debridement (AD)

Autolytic debridement uses moisture-retentive synthetic dressing, permitting devitalized tissue to self-digest from enzymes normally in the wound. AD is indicated when the patient may not tolerate other forms of debridement and would not become infected if the wound was not debrided using faster methods. AD takes longer than other methods.¹

General note: Stable heel ulcers. The AHCPR1 panel’s opinion is that stable heel ulcers with a dry eschar do not need to be debrided if they do not have drainage, fluctuance, erythema, or edema because they provide a natural protective cover. These stable heel ulcers with dry eschar should be monitored daily and must be debrided if signs of pressure ulcer complications appear.

S00-T98 INJURY, POISONING, AND CERTAIN OTHER CONSEQUENCES OF EXTERNAL CAUSES

PROCEDURAL CONCERN

Enzymatic Debridement

Topical debriding enzymatic agents are applied to the wound surface of devitalized tissue and are considered if ulcer is not infected, individuals are in LTC facilities or at home or if surgery cannot be tolerated.¹

S00-T98 INJURY, POISONING, AND CERTAIN OTHER CONSEQUENCES OF EXTERNAL CAUSES

PROCEDURAL CONCERNS

WOUND CLEANING SOLUTIONS

Wounds heal better (optimized) and have lower potential for infection when all wastes, exudate, and necrotic tissue are removed from the wound.

PROCEDURAL CONCERNS

DRESSINGS

Dressings are used to maintain the physiologic integrity of the ulcer so that it protects the wound and provides ideal hydration. They should be biocompatible. Wound cavities are loosely filled with dressing material to prevent the development of abscesses (from walled-off areas).

PROCEDURAL CONCERNS

ADVERSE EVENTS

LITIGATION

1 AHCPR: Treatment of pressure ulcers, clinical guideline No 15 (AHCPR Publication No. 95-0652), December 1994.

2 Bates-Jensen BM. Management of necrotic tissue. In: Sussman C, Bates-Jensen BM, editors. Wound care: A collaborative practice manual for physical therapists and nurses. Gaithersburg (MD): Aspen, 1998.

3 Ramundo J, Wells J. Wound debridement. In Bryant RA, editor: Acute and chronic wounds: nursing management, ed 2, St Louis: Mosby, 2000.

4 Loehne HB. Wound debridement and irrigation. In Kloth LC, McCulloch JM, editors: Wound healing alternatives in management, ed 3, Philadelphia: FA Davis, 2002.

5 Sussman C. Whirlpool. In: Sussman C, Bates-Jensen BM, editors. Wound care: A collaborative practice manual for physical therapists and nurses. Gaithersburg (MD): Aspen; 1998:621-642.

6 Helm PA, Kevorkian CG, Lushbaugh M, et al. Burn injury: rehabilitation management in 1982. Arch Phys Med Rehabil. 1982;63:6-16.

7 Sussman C, Bates-Jensen BM. Wound healing physiology and chronic wound healing. In: Sussman C, Bates-Jensen BM, editors. Wound care: A collaborative practice manual for physical therapists and nurses. Gaithersburg (MD): Aspen, 1998.

8 Medical malpractice, verdicts, settlements, and experts, October 1997, p 40, loc 2.

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