The current healthcare crisis with COVID-19 has left many providers scrambling for a way to meet the needs of their residents and patients while physical contact is restricted during the current pandemic. This is certainly true for Wound Care physicians and nurse practitioners that would normally visit residents in Long Term Care facilities and perform sharps debridement to facilitate wound healing.
To limit exposure to COVID-19, many providers are turning to telehealth modalities in order to virtually “see” patients. As of March 6th, 2020 CMS temporarily expanded benefits to allow Medicare recipients to receive increased telehealth services.5 Providers can assess and recommend treatment for residents, but are faced with the challenge of how to perform a virtual wound debridement.
Types Of Debridement
A quick review of debridement modalities and getting back to basics can help. There are several types of debridement available for effective removal of non-viable tissue:
- Surgical/ Sharps Debridement: This type of debridement is performed with sterile surgical instruments such as curettes or scalpels by the healthcare provider.1 Sharp debridement quickly removes devitalized tissue from the wound bed leaving healthy tissue intact and can be performed in a wound clinic or at the bedside. Surgical debridement is more aggressive and is performed in an operating room and may be non-selective removing healthy tissue as well as devitalized tissue.1
- Enzymatic Debridement: This debridement method is performed by applying an enzyme enriched topical preparation to the wound bed that helps to liquify devitalized tissue.1 Enzymatic debridement is less painful than a surgical/sharps debridement and can be a nurse applied treatment. The negative to this therapy is the high cost of the enzymatic preparation.
- Mechanical Debridement: This type of debridement can be achieved through wet-to-dry dressings or hydrotherapy.1 While this is an inexpensive method, it is usually a painful treatment. This process removes viable and devitalized tissue from the wound bed. Due to the pain involved, this is a less acceptable form of debridement.
- Biological Debridement: This is the use of sterile maggots, Lucilia sericata (the green bottle fly) to debride wounds.1 These maggots are grown in a sterile environment and are applied to the wound bed. Maggots may be applied with custom pre-constructed dressings or individually created dressing to keep the maggots securely in the wound bed.
- Autolytic Debridement: This is a commonly used debridement modality. Autolytic debridement is painless and uses dressings to promote moist wound healing. The wound dressing provides a moisture balanced environment that allows the body’s natural enzymes to liquify devitalized tissue.6 While notably a slower method, the benefit of decreased pain, easy to apply dressings, and lack of trauma to the wound bed makes this a commonly used debridement method.
How To Select A Dressing For Autolytic Debridement
Characteristics to consider in selecting dressings for autolytic debridement include the wound exudate, depth, and condition of the peri-wound skin.4 Commonly used autolytic debridement dressings include products that either add moisture to a wound or those that absorb excess moisture from the wound bed.7 The goal is to maintain a moist wound environment and proper moisture balance in the wound bed to facilitate moist wound healing.8
Dressings to add or retain moisture in the wound include :
- Hydrogels such as DermaSyn, DermaSyn/Ag, or DermaGauze
- Transparent films such as DermaView or DermaView II
- Hydrocolloids such as DermaFilm (clear, HD, thin)
- Collagen gels such as SilvaKollagen Gel
Dressing that absorb excess exudate in the wound, and gel in contact with wound exudate include:
- Alginates such as DermaGinate or DermaGinate/Ag
- Carboxymethyl cellulose (CMC) dressings such as AquaRite Extra CMC
- Collagens such as DermaCol, DermaCol/Ag, DermaCol 100 Sheet or DermaCol 100 powder
Interactive Dressing Selection Guide App
DermaRite’s interactive dressing guide is a unique digital catalog that allows users to input wound information to see which DermaRite dressings are suited for use with that wound. Available for iPhone, iPad and Android.
References:
- https://www.woundsource.com/blog/wound-debridement-options-5-major-methods
- https://www.verywellhealth.com/debridement-of-a-wound-3157191
- https://www.woundsresearch.com/article/evidence-intensive-autolytic-debridement-self-adaptive-wound-dressing
- https://journals.lww.com/aswcjournal/Fulltext/2004/06000/QUICK_TIPS__Dressings_for_Autolytic_Debridement.7.aspx
- https://journals.lww.com/aswcjournal/Citation/publishahead/Expanded_Telehealth_Services_Offer_Smart_Wound.99927.aspx
- https://factdr.com/health-conditions/wound-debridement-dressing/
- https://www.nursingtimes.net/clinical-archive/tissue-viability/the-role-of-debridement-in-the-healing-process-10-10-2013/
- https://www.woundsource.com/blog/benefits-moist-wound-healing
