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10 JCN
Supplement 2016
DEBRIDEMENT
A
ny effective leg ulcer
management model involves
care of the wound and the
skin of the lower limb (Harding
and expert working group, 2015).
Effective skin management
and wound cleansing is a key
component of managing bacterial
bioburden and ensuring that the
periwound margins are in an
optimum condition to promote
healing at the wound edges and
maintain overall skin integrity.
Where ulceration is erosive and
edges unclear, it can be difficult
to know how extensive the actual
ulcer is.
Demystifying debridement and
wound cleansing
Skin changes are commonly seen
around venous leg ulcers as a result
of venous changes. In addition to the
thickening of the subcutaneous tissue
(lipodermatosclerosis) it is common
to see redness, scaling, weeping and
crusting around a wound; these are
all features of dermatitis or eczema
(interchangeable terms). In some
patients the top layers of the skin
become very thickened with scale or
covered with adherent old keratin
(hyperkeratosis).
BACKGROUND
Skin barrier function
Maintaining skin barrier function
is an important part of skin care.
The skin has many functions,
importantly as a barrier and an
immunosurveillance organ (Ryan,
2013). Loss of the barrier function
results in an inability to control
transepidermal fluid loss, leading
to inflammation, dryness and
potentially infection.
Wound fluid
Wound fluid (exudate) can also
Annette Downe, epidermolysis bullosa
clinical nurse specialist, St Thomas’ Hospital,
London; Salma Khatun, student nurse,
King’s College London
In the community setting, leg ulcer management involves
both care of the wound itself and the skin of the lower limb.
Cleansing is vital to enure that infection does not develop in
the wound itself and that the integrity of the periwound skin is
maintained. Maintaining the skin’s barrier function is also vital,
as, without this, fluid loss, inflammation, dryness and infection
can develop. Wound exudate can also act as an irritant to healthy
skin, particularly when permitted to accumulate under wound
dressings. Keeping the skin clean and free of debris, alongside
more frequent dressing changes can help in the treatment of
irritated skin. This article highlights the use of an innovative
cleansing product (UCS
™
; medi UK), which is designed as a
premoistened cloth that safely and efficiently cleanses the wound
of slough and debris, while rehydrating periwound skin.
KEYWORDS:
Leg ulcers
Skin cleansing
Rehydration
Periwound skin
Annette Downe, Salma Khatun
be very irritant to healthy skin
especially under some dressings.
Effective skin cleansing regimens,
together with more frequent
dressing changes can be helpful in
treating very irritated skin.
Clinicians may often concentrate
upon the dressing change at the
expense of effective skin hygiene.
There may be a number of historic
reasons for this, such as the time and
effort required for a traditional wash
with bucket and water.
Debridement
On occasions the objective may be
to debride the tissue. Debridement
is different to cleansing, which is
simply the removal of dirt from a
wound (Kamolz and Wild, 2016).
Debridement can be defined as the
removal of devitalised tissue, infected
tissue, hyperkeratosis, slough, pus,
debris or any other type of bioburden
from a wound to promote healing
(Strohal et al, 2013).
Chronic wounds such as leg ulcers
or pressure ulcers often contain dead
tissue and bacteria. This can be either
dry and‘leathery’ in appearance,
which is known as eschar; or soft
and coloured brown, grey or yellow,
which is known as slough. Slough is
made up of white blood cells, bacteria
and debris, as well as dead tissue, and
is easily confused with pus, which is
often present in an infected wound.
Chronic wounds are likely to
need repeated debridement as part
of ongoing wound care to remove
slough, a gel-like mass of dead or
living bacteria, fibrin and tissue-
destroying enzymes at the base of
a chronic wound. Slough prevents
normal healing (Mooney, 2009).
While debridement is a
process that occurs naturally in