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DEBRIDEMENT
W
ound bed preparation and
care of the periwound
skin are essential
components of venous leg ulcer
management, with debridement
being integral to achieving effective
wound management (Strohal
et al, 2013; Wounds UK, 2013).
The community nurse plays an
important role in delivering wound
care, from wound assessment
and debridement of non-viable
tissue, to referral to other clinicians
if indicated. Traditionally, the
choices of debridement available
to practitioners working in the
community setting have been
limited. Clinicians have generally
relied on speeding up the natural
process of autolytic debridement
through the use of wound
dressings. However, this technique
involves patients having extended
periods with non-viable tissue
in their wound, which ultimately
delays healing and puts them at
increased risk of developing a
wound infection (Young, 2012).
‘Autolytic debridement is often
selected by clinicians due
to their familiarity with the
technique, or because they
do not have the knowledge
of other debridement options,
rather than because it is in the
best interests of the patient’
Simon Barrett,Tissue Viability Lead Specialist,
Humber NHS Foundation Trust
In the current healthcare climate,
clinicians are expected to deliver
evidence-based practice, that is
practice supported by evidence
of its cost- and clinical-efficacy.
This article highlights the need
for practitioners to be aware of
advances in debridement (Strohal et
al, 2013), and to carry out evidence-
based practice that optimises
outcomes for patients, clinicians
and trusts alike, rather than relying
on routine or ritualistic practice.
Debridement in
the community
Debridement is the removal of non-
viable tissue from the wound bed to
encourage wound healing and, as
said, is an essential part of wound
care (Strohal et al, 2013). Devitalised
tissue acts as a focus for infection,
providing a breeding ground for
bacteria and a physical barrier to
healing. Its presence prolongs the
Are you debriding based on
today’s evidence?
inflammatory response, delaying
wound healing. Devitalised tissue
also conceals the wound bed and
makes accurate wound assessment
difficult (Stephen-Haynes and
Callaghan, 2012).
It is also widely accepted that
periwound skin cleansing, which
includes the removal of skin debris,
is an essential component of good
wound care (Vowden and Vowden,
2011).
Devitalised tissue may present as
yellow, grey, purple, black, or brown
tissue. It may be dry necrosis, wet
necrosis, wet slough, superficial wet
slough, dry slough, haematoma, or
hyperkeratosis of periwound skin
(Gray et al, 2011).
Autolytic, mechanical and larval
debridement methods are used in
the community setting as they do
not require additional skills, are
available on prescription, and can
be used safely (Wounds UK, 2013).
Of these, autolytic debridement has
traditionally been used, rather than
mechanical and larval techniques.
This has resulted in debridement
becoming ritualistic in some
cases, with the nurse choosing
this debridement method due to
familiarity with the technique,
or because they do not have the
Simon Barrett
4 JCN supplement
2014,Vol 28, No 6
IN BRIEF
Wound debridement is essential for accurate wound assessment,
wound bed preparation and care of the periwound skin in patients
with venous leg ulceration.
Traditional debridement methods can be time-consuming and
costly, with practice based on routine and familiarity rather
than evidence.
NICE recommend that Debrisoft
®
results in quicker debridement
with fewer nurse visits compared with other available options.
KEY WORDS:
Wound debridement
Venous leg ulcers
Debrisoft
®
NICE guidelines
Cost-effectiveness