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DEBRIDEMENT
slow process of individually picking
off hyperkeratotic scales. The survey
concluded that there was no standard
approach to the management of
hyperkeratosis across Wales. This
led to the development of the first
National Guidance document (Crook
et al, 2014).
The document highlights the
NICE recommendations for the
effectiveness and short procedure
time of using Debrisoft to remove
hyperkeratosis, recommending its
use as part of best practice.
Benefits in the community
Safe and rapid debridement in the
community setting can have many
advantages. A three-week evaluation
of Debrisoft by a group of tissue
viability link nurses found that not
only did Debrisoft achieve ‘timely,
optimal, pain-free removal of non-
viable tissue’, it also helped wound
assessment and thereby treatment
objectives by making the wound
bed more visible, which previously
might have taken weeks to achieve
(Stephen-Haynes and Callaghan,
2012). Furthermore, Callaghan and
Stephen-Haynes (2012) reported
that debriding with Debrisoft
resulted in a definite reduction
in subsequent visits required to
perform an aspect of wound care in
11 out of 12 patients.
Girip and McLoughlin (2013)
stated that safe, rapid and effective
debridement had been limited in
the community for many years
and would normally have required
a specialist nurse referral and a
hospital admission. In a case study,
debridement of the wound and skin
was successfully completed in one
session with Debrisoft, enabling
the patient to remain in her own
home to continue with skin care and
compression therapy. They state that
Debrisoft is an ideal debridement
method for district nurses, enabling
them to perform safe and rapid
debridement at the bedside.
An evaluation of the role of
Debrisoft within the selection of
wound dressings available in the
‘first dressing box’was carried out in
a rural area of North West Wales by
declining workforce, lack of training
and budget cuts, the use of Debrisoft
can play an important part in
assisting the practitioner to instantly
remove soft, non-viable tissue from
the wound bed. Other debridement
methods may take longer to perform
the same task and thus put the
patient at increased risk of wound
infection and delayed healing.
Debrisoft can also be used to
prepare the limb for compression
therapy by quickly removing skin
debris such as dry flakes and
hyperkeratosis, which frequently
two tissue viability nurses. Data from
16 evaluations was analysed and
found that the active debridement
system was a useful addition to the
first dressing initiative. Debrisoft
improved visualisation, which aided
accurate assessment of the wound
bed, and led to reduced debridement
time and quicker progression on
to the next stage of wound healing
(Lloyd-Jones and Parry-Ellis, 2012).
Conclusions
In the current community nursing
climate of increasing caseloads,
An 81-year-old patient presented with a history of venous leg
ulceration and varicose eczema
(Figure 1).
Over a three-year
period the patient suffered from wound deterioration, infection,
severe hyperkeratosis and varicose eczema, resulting in a cycle
of visits to various medical specialists. Despite the support of
the tissue viability nurse, a full holistic leg ulcer assessment,
compression therapy and appropriate treatment, the wound
continued to deteriorate, improve and then deteriorate again
(Figure 2).
The costs associated with the management of this particular wound
and skin condition were considerable. This included 3–4 episodes
of nurse time per week over the three-year period, antibiotics on
a regular basis, hospitalisation, wound dressings and bandages
and various creams such as steroids and emollients. Debrisoft
®
, a
monofilament debridement pad, was used to remove slough
from the wound and hyperkeratosis from the periwound area, to
promote healing.
Debrisoft was used at each clinic visit on five occasions over a two-
week period. Debridement time varied between 2 and 10 minutes and
a positive outcome was noticed immediately on all five occasions. Pain
scores using a visual analogue scale (VAS) were 0 during treatment and
0 after treatment on all five occasions (where 0=no pain).
The wounds and varicose eczema healed following the two weeks of
treatment (
Figure 3
), with compression hosiery being used to maintain
healing. The debridement pad was used twice to prevent the build-up
of hyperkeratosis.
Case report
JCN supplement
2014,Vol 28, No 6
7
Figure 1.
Figure 3.
Figure 2.