How to Clean Wounds and Help Healing
The Basics of Debridement in Bedsores and Burns
Depending on the size and severity of a wound, and on factors such as the patient's wishes, condition, and habits, doctors, nurses and other practitioners must choose whether or not it is appropriate to debride a wound. If debridement is appropriate, there are several methods that may be used.
Debridement by Mechanical Means
In emergency situations a surgeon or other trained practitioner may use metal instruments to remove dead tissue and infection from a wound. This is called "Sharp debridement" and is most often done under anesthesia prior to skin grafting.
Wet to dry dressings are the most common form of mechanical debridement used in home settings. A gauze dressing moistened with saline or water is fluffed to fill spaces and loosely applied to the wound. It is covered by a dry dressing and taped in place. When both dressings are dry, it is removed. Dead tissue and waste materials stick to the dried dressing and are pulled away. This may be painful to patients and must be done with the frequency of dressing changes.
Moving water can be used to debride wounds. Whirlpool and pulse washes effectively remove loose exudate, but are contraindicated where cross contamination of wounds or incontinence in bathwater are a factor.
Application of Maggots
Also known as biodebridement, blowfly larvae are known to clean wounds and leave behind antimicrobial substances. Early military conflict showed that when maggots had access to battlefield wounds, the wounds healed better and were less likely to become infected. Although distasteful, good results have been achieved with biodebridement. The larvae are unable to survive if hydrogel dressings have previously been used on the wound (Options for Non-surgical Debridement of Wounds, Singhal A., et.al., Journal for Prevention and Wound Care, 2001). Antartic Krill, a type of shrimp, have also shown promise in animal studies.
Applications of Chemicals
Enzymes specific to the types of matter adhering to wounds can be used to dissolve those substances. These enzymes are categorized as proteolytics, fibrinolytics, and collegenases (Outcomes of Four Methods of Debridement, Mosher B., et. al., Advances in Wound Care, 1999). When accidentally applied to healthy tissue they are harmful. Wounds should be irrigated prior to application and an antibiotic ointment should be used afterward according to the manufacturer's instructions. Chemical debridement is favored in nursing homes when surgery is not an option. It is safe and effective when properly used.
New Materials Hold Moisture
When wounds are in a moist environment, naturally present enzymes and digestive materials clean and stimulate wound healing. Foam dressings for this purpose can be fitted and applied to moderate injuries, transparent dressings are effective on superficial wounds. Hydrogels humidify and have a cooling, soothing effect on wounds but must be used with care as they can macerate surrounding healthy tissue. Alginates are natural derivatives of seaweed which hold moisture and do not inhibit wound closure (Singhal, A, 2001). All types of materials should be loosely packed into wound spaces to prevent the formation of abcessed pockets.
Methods of debridement may be combined or changed as the condition of the wound improves. The most effective treatments have sound clinical judgement behind them and are helped by patient compliance.
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