what to use on wounds that have necrotic tissue
Printer-friendly version By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS
Necrotic tissue that is nowadays in a wound presents a physical impediment to healing. Simply put, wounds cannot heal when necrotic tissue is nowadays. In this article, we'll define necrotic tissue and depict means to effect its removal from the wound bed.
What is necrotic tissue?
Necrotic tissue is dead or devitalized tissue. This tissue cannot be salvaged and must be removed to allow wound healing to take place. Slough is yellowish and soft and is composed of pus and fibrin containing leukocytes and bacteria. This tissue ofttimes adheres to the wound bed and cannot exist easily removed. Eschar is black, dry and leathery and may form a thick covering like to a scab over the wound bed below it.
Necrotic tissue comprises a physical barrier that must be removed to permit new tissue to form and embrace the wound bed. Necrotic tissue is a vital medium for bacterial growth, and its removal will go a long way to decreasing wound bioburden.
Managing necrotic tissue
Necrotic tissue must be removed. How can this be accomplished? There are several methods to remove necrotic tissue:
- Autolytic debridement: Autolytic debridement leads to softening of necrotic tissue. It can be achieved using dressings that add together or donate moisture. This method uses the wound's ain fluid to suspension down necrotic tissue. Semi-occlusive or occlusive dressings are primarily used. Diverse gel formulations tin can as well exist used to assist speed the breaking down of necrotic tissue. Intendance must be taken to protect the pare surrounding the wound from becoming macerated. Autolytic debridement should not be used (or should be used with keen caution) on diabetic wounds or wounds caused by arterial insufficiency.
- Mechanical debridement: This method is used less frequently. It involves the use of wet-to-dry dressings that permit the elevation layer of devitalized tissue to be peeled abroad when the dressing is removed. Unfortunately, this method can remove healthy tissue also. This method may also be more than painful for the patient. It requires frequent dressing changes, so this method may not be suitable for all patients.
- Precipitous debridement: This method involves the trimming away of necrotic tissue using sterile scissors and forceps; it may be washed at the patient's bedside or in a treatment room. Obviously, the clinician performing this type of debridement must have adequate noesis of debridement technique and anatomy to avoid cutting into vital structures. Sharp debridement often requires more than one treatment (serial debridement). Information technology tin exist a very effective method to jump-starting time a stalled wound.
- Surgical debridement: Surgical debridement is performed in the operating room under general or local anesthesia. It is used when a large surface area of necrotic tissue must be removed and clear margins are needed, every bit may exist the case with infection. This method may create a much larger wound, but the wound volition be clean and may heal much faster. This method is much more expensive and is usually reserved for large and badly infected wounds.
- Larval (maggot) therapy: Maggots that accept been raised in a sterile environment accept been used successfully to debride necrotic wounds. The maggots secrete an enzyme which breaks down necrotic tissue so that information technology tin can exist ingested by the maggots. The maggots volition non swallow healthy tissue. Many patients find the mere idea of maggot therapy distasteful - obviously, these patients are non suitable candidates for this type of therapy.
Wounds that have necrotic tissue nowadays volition not heal, therefore i of the above methods will be required to remove the devitalized tissue. Removal of necrotic tissue will decrease wound bacterial bioburden and will permit salubrious tissue to grow in its place.
Source:
Leak K. How to... X height tips for wound debridement. Wounds International. 2012;three(1):21-23.
Most The Writer
Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS is a Certified Wound Therapist and enterostomal therapist, founder and president of WoundEducators.com, and advocate of incorporating digital and figurer technology into the field of wound care.
The views and opinions expressed in this blog are solely those of the author, and practice not represent the views of WoundSource, Kestrel Health Data, Inc., its affiliates, or subsidiary companies.
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