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Pressure Ulcers

Methods of Pressure Ulcer Debridement

 

Method Definition Indications Contraindications
Autolytic A selective method of natural debridement promoted under occlusive or semiocclusive moisture-retentive dressings that results in solubilization of necrotic tissue only by phagocytic cells and by proteolytic and collagenolytic enzymes inherent in the tissues.
  • Individuals on anticoagulant therapy
  • Individuals who cannot tolerate other forms of debridement
  • All necrotic wounds in people who are medically stable
  • Infected wounds
  • Wounds of immunosuppressed individuals
  • Dry gangrene or dry ischemic wounds
Enzymatic A selective method of chemical debridement that promotes liquefication of necrotic tissue by applying topical preparations of proteolytic or collagenolytic enzymes to those tissues. Proteolytic enzymes help loosen and remove slough or eschar while collagenolytic enzymes digest denatured collagen in necrotic tissue.
  • All moist necrotic wounds
  • Eschar after cross-hatching
  • Homebound individuals
  • People who cannot tolerate surgical debridement
  • Ischemic wounds unless adequate vascular status has been determined
  • Dry gangrene
  • Clean, granulated wounds
Mechanical A nonselective method of debridement that not only removes foreign material and devitalized or contaminated tissue by physical forces (wet-to-dry gauze dressing, dextranomers, pulsatile lavage with suction or whirlpool), but may also remove healthy tissue as well.
  • Wounds with moist necrotic tissue or foreign material present
  • Clean, granulated wounds
Sharp

A selective method of debridement using sterile instruments (scalpel, scissors, forceps, silver nitrate sticks) that sequentially removes only necrotic wound tissue without anesthesia and with little or no bleeding induced in viable tissue.

  • Scoring and/or excision of leathery eschar
  • Excision of moist necrotic tissue
  • Clean wounds
  • Advancing cellulitus with sepsis
  • When infection threatens the individual's life
  • Individual on anticoagulant therapy or has coagulopathy
Surgical The most efficient method of debridement. It is nonselective and is performed by a physician or surgeon using sterile instruments (scalpel, scissors, forceps, hemostat, silver nitrate sticks) in a onetime operative procedure. The procedure usually removes most, if not all, necrotic tissue, but may also remove some healthy tissue in what is termed wide excision. Because there may be associated pain and/or bleeding, the individual may require anesthesia, and the procedure will likely require an operating or special procedures room.
  • Advancing cellulitus with sepsis
  • Immunocompromised individuals
  • When infection threatens the individual's life
  • Clean wounds as a preliminary procedure to surgical wound closure line.
  • Granulation and scar tissue may be excised
  • Cardiac disease, pulmonary disease, or diabetes
  • Severe spasticity
  • Individuals who cannot tolerate surgery
  • Individuals who have a short life expectancy
  • Quality of life cannot be improved

Reproduced with permission from the Paralyzed Veterans of America (PVA) Consortium for Spinal Cord Medicine Clinical Practice Guidelines “Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury: A Clinical Practice Guideline for Health-Care Professionals” Washington, DC: © 2000 Paralyzed Veterans of America.

Copies of the PVA’s Guidelines are available at www.pva.org or through the PVA Distribution Centre (toll free 888-860-7244).