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Summary
Wound debridement is an essential part of effective wound care. There are many methods of debriding wounds and it is important that patients are involved in the decision so that they are able to give informed consent. To make effective clinical decisions and ensure patients are fully informed it is essential that nurses are aware of the different methods of debriding wounds. The nurse should also be aware of the professional requirements for competence and the risks and benefits of each method. A guideline for conservative sharp debridement has recently been published by the Tissue Viability Nurses Association (TVNA 2005), and this article reviews the issues related to the procedure and the alternatives available.
Keywords
Debridement methods; Tissue viability; Wounds
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DEBRIDEMENT IS the 'removal of devitalised or infected tissue or foreign material from a wound' (National Institute for Clinical Excellence (NICE) 2001 ). Although research is lacking to state categorically that debridement is necessary for wound healing, a wealth of clinical experience over many years exists to indicate that in many cases healing progresses much more rapidly following debridement and it is accepted practice in good wound care (NICE 2001 ). This is particularly evident in the reduced risk of infection with the removal of devitalised tissue. A recent comparative study demonstrated a statistically significant increase in healing following debridement of venous leg ulcers compared with no debridement (Williams et al 2005).
Necrotic tissue is dry, leathery in texture and dark in colour. If and when it softens it changes in shade to brown/yellow or grey and becomes stringy and wet depending on the moisture level (O'Brien 2002). The presence of dead and dry tissue inhibits cell activity, particularly the action of white cells to clear bacteria and debris; this debris produces toxins and, in turn, more bacteria, eventually overwhelming the host defences to produce clinical infection (Flanagan 1997). Necrotic tissue forms a physical barrier to the movement of epithelial cells striving to form new epidermis over the wound (Milward 1995). Debridement of wounds also...