WOUND DEBRIDEMENT

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INTRODUCTION:
Wound debridement is a medical procedure in which dead, damaged and infected tissues as well as foreign bodies in a wound is removed to facilitate healing.  It is a very important procedure because presence of necrotic or dead tissues in a wound prevents the physiological process of wound healing whereby granulation tissue formation is limited if not stoped.  
Organisms can colonize the wound through these necrotic tissues which generally can result in infection of the wound therefore debridement reduces risk of infection and facilitates healing. 

Not all wounds may require debridement. Mainly wound which requires debridement are old or severe wounds which aren't getting better or is at risk of infection. Examples are Chronic ulcers, severe burns, etc.

TYPES OF DEBRIDEMENT 
Biological debridement 
Enzymatic debridement 
Conservative sharp or surgical sharp debridement 
Mechanical debridement 
Autolytic debridement 

1: BIOLOGICAL DEBRIDEMENT 
It is also called maggot therapy. It involves use of maggots from the green bottle fly ( Lucilia sericata ).
This method has existed for many years even before the discovering of antibiotics in 1940. 
The maggots help wound healing by eating old tissue. They also control infection by releasing antibacterial substances and eating harmful bacteria. The maggots are placed on the wound  and left for about 2 to 3 days. It is replaced twice a week.
It's a  necessary for patients who have medical conditions that might hinder the choice of surgery or patient whose wound is infected by bacteria resistance to antibiotics.


2: ENZYMATIC DEBRIDEMENT 
Patients who have bleeding problem can go for this. It involves use of ointments which contain enzymes that soften the hard dead tissues.  As dressing of the wound is removed,  the dead tissues are removed. 

3: CONSERVATIVE SHARP OR SURGICAL DEBRIDEMENT 
Here, unhealthy tissues are cut off. This type of debridement is performed by a skilled practitioner using surgical instruments. It promotes wound healing by removing biofilm and devitalized tissue. 
Conservative sharp can be done by any medical or health practitioner as it is a minor bedside surgery. 
Healthy tissues are not removed and anaesthesia is not used unlike surgical sharp.  One used scalpels,  curettes or scissors. 
                                CONSERVATIVE SHARP DEBRIDEMENT 
Surgical debridement is the most aggressive type of debridement and is performed in a surgical operating room. Sharp and conservative debridement can be performed in a clinic or at the bedside with sterile instruments. In severe cases of necrotising fasciitis,  surgical sharp debridement is necessary. 
Anaesthesia is used and healthy tissues as well can be removed. 
                               SURGICAL SHARP DEBRIDEMENT 


4: MECHANICAL DEBRIDEMENT 
It's a very common type and its cost effective but can damage healthy tissue.  Its also usually painful. 
It involves three methods which are:0
Hydrotherapy. This method uses running water to wash away old tissue. 
Wet-to-dry dressing. Wet gauze is applied to the wound. After it dries and sticks to the wound, it’s physically removed, which takes away dead tissue.
Monofilament debridement pads. A soft polyester pad is gently brushed across the wound. This removes bad tissue. Its for noninfected and infected wounds.


5: AUTOLYTIC DEBRIDEMENT 
This method uses the body's own enzymes and moisture beneath  the dressing to liquefy unhealthy tissues. Its not a painful procedure. Its also common. The dressings are changed daily. 

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