Transcript No Slide Title

INDICATIONS AND
CONTRAINDICATIONS FOR SHARP
DEBRIDEMENT
Indications for sharp debridement: When do we debride?
• Presence of devitalized tissue
• Presence of gross infection
• Amount of necrotic tissue so great that other methods
would be too slow
• Adjunct to other methods of debridement
“IF IT’S DEAD, IT’S DEAD.”
- Glenn Silverstein, DPM September 13, 2012
Contraindications for Sharp Debridement
• Patient is on an anticoagulant: especially parenteral
• Patient has a disorder such as hemophilia or other
coagulopathy
• There is a reason the patient cannot stay still which
could cause harm to the debrider or debridee!
• No consent
Contraindications for Sharp Debridement
• Poor vascular perfusion
• Inadequate anesthesia
• Cannot properly identify anatomic structures
• Good healthy granulation tissue
Wound Assessment
• Know the patient! i.e. Medical history, current meds.,
history of the wound
• Know the anatomy of the area to be debrided
• Identify the wound type, tissue type
Know the patient: Medical History
Diabetes, peripheral vascular disease, collagen vascular
disease, cancer, nutritional status, cigarette usage, alcohol or
illegal drug use, family support, etc.
Know the patient: Medications
• Insulin (diabetes well controlled?), coumadin, heparin,
Lovenox, Plavix, steroids
Know the patient: Wound History
• How did the wound occur?
• How long has it been present?
• What treatments have been used?
• Is it improving, worsening or staying the same?
Know the anatomy!
Know the wound type
Arterial, venous, diabetic (neuropathic), burn, insect
bite, collagen vascular, pressure
Identify the tissue type
• Eschar/Necrotic
• Erythema/Edema/Venous stasis
dermatitis
• Slough/Fibrin
• Induration/Blistering/abscess (fluctuant)
• Keratosis/Maceration/Dead Fat
• Perfusion Vs. No perfusion
• Color/Granulation
tissue/Hypergranulation
• Purulence/Sinus Tract/Tunneling
• Woody/Fibrotic/Dermatosclerosis
• Hematoma
Eschar
Necrosis
Erythema
Edema
Slough
Fibrin
Induration
Blistering/abscess
Keratosis
Maceration
Dead fat/fascia
Perfusion
No perfusion
Color
Granulation
Tissue
Hypergranulation
Purulence
Sinus
Tract/Tunneling
Woody/Fibrotic
“lipodermatosclerosis”
Hematoma
Heart shaped wound