Debridement is a Critical Part of Wound Care
Stage I and stage II pressure sores usually heal within several weeks to months with conservative care of the wound and with ongoing, appropriate general care that manages risk factors for pressure sores. Stage III and IV pressure sores are more difficult to treat. In a person who has a terminal illness or multiple chronic medical conditions, pressure sore treatment may focus primarily on managing pain rather than complete healing of a wound.
Addressing the many aspects of wound care usually requires a multidisciplinary approach. Members of a care team may include:
- A primary care physician who oversees the treatment plan
- A physician specializing in wound care
- Nurses or medical assistants who provide both care and education for managing wounds
- A social worker who helps a person or family access appropriate resources and addresses emotional concerns related to long-term recovery
- A physical therapist who helps with improving mobility
- A dietitian who assesses nutritional needs and recommends an appropriate diet
- A neurosurgeon, orthopedic surgeon or plastic surgeon, depending on whether surgery is required and what type of surgery is needed
The first step in treating a sore at any stage is relieving the pressure that caused it. Strategies to reduce pressure include the following:
- Repositioning. A person with pressure sores needs to be repositioned regularly and placed in correct positions. People using a wheelchair should change position as much as possible on their own every 15 minutes and should have assistance with changes in position every hour. People confined to a bed should change positions every two hours. Lifting devices are often used to avoid friction during repositioning.
- Support surfaces. Special cushions, pads, mattresses, and beds can help a person lie in an appropriate position, relieve pressure on an existing sore and protect vulnerable skin from damage. A variety of foam, air-filled or water-filled devices provide cushion for those sitting in wheelchairs. The type of devices used will depend on a person’s condition, body type and mobility.
Removing damaged tissue:
To heal properly, wounds need to be free of damaged, dead or infected tissue. Removing these tissues (debridement) is accomplished with a number of methods, depending on the severity of the wound, your overall condition and the treatment goals. Options include:
- Surgical debridement involves cutting away dead tissues.
- Mechanical debridement uses one of a number of methods to loosen and remove wound debris, such as a pressurized irrigation device, a whirlpool water bath or specialized dressings.
- Autolytic debridement, the body’s natural process of recruiting enzymes to break down dead tissue, can be enhanced with an appropriate dressing that keeps the wound moist and clean.
- Enzymatic debridement is the use of chemical enzymes and appropriate dressings to break down dead tissues.
Cleaning and dressing wounds:
Care that promotes healing of the wound includes the following:
- Cleaning. It’s essential to keep wounds clean to prevent infection. A stage I wound can be gently washed with water and mild soap, but open sores are cleaned with a saltwater (saline) solution each time the dressing is changed.
- Dressings. A dressing promotes healing by keeping a wound moist, creating a barrier against infection and keeping the surrounding skin dry. A variety of dressings are available, including films, gauzes, gels, foams and various treated coverings. A combination of dressings may be used. Your doctor selects an appropriate dressing based on a number of factors, such as the size and severity of the wound, the amount of discharge, and the ease of application and removal.
Other interventions that may be used are:
- Pain management. Interventions that may reduce pain include the use of nonsteroidal anti-inflammatory drugs — such as ibuprofen (Motrin, Advil, others) and naproxen (Aleve, others) — particularly before and after repositioning, debridement procedures and dressing changes. Topical pain medications, such as a combination of lidocaine and prilocaine, also may be used during debridement and dressing changes.
- Antibiotics. Pressure sores that are infected and don’t respond to other interventions may be treated with topical or oral antibiotics.
- Healthy diet. Appropriate nutrition and hydration promote wound healing. Your doctor may recommend an increase in calories and fluids, a high protein diet, and an increase in foods rich in vitamins and minerals. Your doctor may also prescribe dietary supplements, such as vitamin C and zinc.
- Muscle spasm relief. Muscle relaxants — such as diazepam (Valium), tizanidine (Zanaflex), dantrolene (Dantrium) and baclofen — may inhibit muscle spasms and enable the healing of sores that may have been caused or worsened by spasm-related friction or shearing.
Pressure sores that fail to heal may require surgical intervention. The goals of surgery include improving the hygiene and appearance of the sore, preventing or treating infection, reducing fluid loss through the wound, and lowering the risk of cancer.
The type of reconstruction that’s best in any particular case depends mainly on the location of the wound and whether there’s scar tissue from a previous operation. In general, though, most pressure wounds are repaired using a pad of the person’s own muscle, skin or other tissue to cover the wound and cushion the affected bone (flap reconstruction).
About the Author
Attorney Steven Peck has been practicing law since 1981. A former successful business owner, Mr. Peck initially focused his legal career on business law. Within the first three years, after some colleagues and friend’s parents endured nursing home neglect and elder abuse, he continued his education to begin practicing elder law and nursing home abuse law.