Surgery Book

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Wound DebridementAka: Decubitus Ulcer Debridement, Sharp Debridement, Mechanical Debridement, Autolytic Debridement, Enzymatic Debridement

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  1. Goal
    1. Preserve granulation tissue (pink)
    2. Debride fibrin tissue (white, yellow, or green tissue)
    3. Debride necrotic tissue (black wound)
      1. Full thickness burn (third degree burn)
      2. Pressure Sore (Stages 3 or 4)
      3. Gangrenous ulcer
    4. Exceptions: Stable healing ulcer with dry eschar
      1. Dry eschar does not require debridement
      2. Debridement indications
        1. Edema or erythema
        2. Fluctuance
        3. Discharge
  2. Techniques
    1. Sharp debridement
      1. Scalpel or scissors to remove devitalized tissue
      2. Indications
        1. Removing adherent eschar
        2. Devitalized tissue in extensive ulcer
        3. Urgent debridement in advanced Cellulitis or Sepsis
      3. Follow-up sharp debridement
        1. Apply clean, dry dressings for 8-24 hours
        2. Restart wet-to-moist (or wet-to-dry) dressings
      4. Debridement under Anesthesia Indications
        1. Indicated for extensive stage 4 Decubitus Ulcers
        2. Consider bone biopsy to assess for Osteomyelitis
    2. Mechanical Debridement
      1. Wet-to-Dry Dressing
      2. Hydrotherapy (Occlusive Wound Dressing)
        1. Transparent Film Dressing
      3. Wound irrigation
      4. Dextranomers
    3. Enzymatic debridement
    4. Autolytic debridement
      1. In vivo enzymes self-digest devitalized tissue
      2. Synthetic dressing applied to cover wound
      3. Contraindicated for infected wounds

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