6 / 16
DEBRIDEMENT
moving the patient to healing more
rapidly (Flinton, 2011). In addition,
it reduces the number of subsequent
wound care visits required by
patients (Callaghan and Stephen-
Haynes, 2012).
The NICE guidance cost
calculator estimated that using
Debrisoft within the community
can save the NHS up to £484 per
patient for complete debridement
of a wound, compared to current
standard practice. NICE estimate
that using Debrisoft could save
the NHS as much as £15 million
annually (NICE, 2014).
Debridement in the
management of the
lower limb
Debrisoft is indicated for
debridement of the lower limb,
including leg ulcers, management
of varicose eczema as a result of
venous disease, and management of
dry skin and hyperkeratosis which
occurs as a result of lymphovenous
disease (Whitaker, 2012; Pidcock
and Jones, 2013).
Adopting an holistic approach
to assessment and the subsequent
care planning is well documented
for managing chronic conditions,
particularly for the management
of venous and lymphatic disorders
(Lymphoedema Framework 2006;
Jones, 2014). Thorough skin care is
an essential component of lower
limb care. While compression
therapy is vital, it should not be
used in isolation and should be
considered as a component of care.
Management of
hyperkeratosis
Dry skin is common and can
be uncomfortable, itching and
stinging. In patients undergoing
weekly bandaging in particular,
skin can be itchy. Normally skin
cells are shed during washing,
movement and dressing. In
patients wearing compression
bandaging for up to a week, this
process is affected and dry skin
can build up. Hyperkeratosis is the
over-proliferation of the keratin
layer of skin and usually manifests
as discoloured scales on the skin’s
improves the efficacy of topical
treatments such as creams
and emollients.
Removal of hyperkeratotic
scales must be safe and atraumatic
(Whitaker, 2012). It is recommended
that plaques are not removed
with sharp implements, as this
may lead to bleeding, pain and
infection. However, this is frequently
done in practice, as is manually
removing scales using a gloved
finger or forceps. This approach is
time-consuming: scales must first
be softened with emollients and
complete removal is unlikely to be
achieved in one episode of care,
but may require several treatments
(Crook et al, 2014).
A survey of members of the
All Wales TissueViability Nurse
Forum was undertaken to establish
current practice in Wales for the
management of hyperkeratosis
as part of leg ulcer management
(Young, 2011; Crook et al, 2013). The
survey found that hyperkeratosis
management accounted for large
proportions of their caseload, with
treatment sessions lasting between
10 and 30 minutes. The longer
treatment times were due to the
‘Adopting an holistic
approach to assessment
and the subsequent care
planning is well documented
for managing chronic
conditions, particularly for
the management of venous
and lymphatic disorders’
surface (Pidcock and Jones, 2013).
In between the scales, cracks
appear and the mortar which
binds the skin cells in normal
conditions breaks down, allowing
foreign bodies to enter and
thus putting the patient at risk
of infections such as cellulitis
(Whitaker, 2012).
D
ebrisoft
®
has multiple
benefits in our practice in
the community. It is very
quick to use and most patients love
the rapid result and the often instant
improvement in their skin and/
or wound.
The ease of use often leads
to patients becoming involved in
their self-care. This is an advantage
for those with painful wounds, or
patients who fear having their wound
touched, particularly children. Often
these patients will happily debride
their wounds and skin themselves
using Debrisoft under nurse
supervision, and will continue to self-
care, or realising that it doesn’t hurt,
Expert commentary
Rosie Callaghan,Tissue Viability Nurse Specialist,
Worcester Health and Care Trust
allow treatment to be carried out by
the clinician.
Healthcare assistants frequently
use Debrisoft as part of routine skin
care; it is simple to use and yields
immediate improvement of skin
condition, preparing it for the use of
emollients, cream or compression.
For trained staff, Debrisoft is often
used to debride static wounds, as it
seems to reduce wound bioburden
and puts the wound back on a
healing trajectory.
We have been honest in our
approach to using Debrisoft. There are
no secrets; it looks simple and it is!
6 JCN supplement
2014,Vol 28, No 6
Whitaker (2012) highlighted that
failing to manage hyperkeratosis
while applying compression can
lead to further skin deterioration,
including maceration. Conversely,
the removal of hyperkeratosis and
softening of the tissues prepares
the limb for effective compression
(Flinton, 2011;
Case report
), and