Can New Hemostatic Dressings Facilitate Sharp Debridement In High-Risk Patients?

Author(s): 
Clark Schierle, MD, PhD, and Julie Krol, MS, PA-C

   Sharp debridement is a critical step to promote healing and allow the body to repair chronic wounds as naturally and healthily as possible. Removing necrotic tissue and biofilm from the surface of chronic wounds converts chronic wounds into acute ones, effectively “resetting” the wound healing cascade and allowing the healing process to take place.

   Successful debridement and subsequent wound closure reduce the risk of infection, reduce hospital stays and improve a patient’s overall quality of life. Sharp debridement requires the surgical experience, skills and tools to safely manage potential complications, control bleeding and prevent additional infection. Using chitosan-based hemostatic bandages, wound care specialists can perform more sharp debridements on high-risk patients in a convenient, safe outpatient setting or in an inpatient setting as needed.

   Wounds such as diabetic ulcers, pressure sores and venous stasis ulcers often present wound care specialists with necrotic eschar that requires aggressive debridement. These wounds often occur in patients with multiple comorbidities, making a general anesthetic dangerous. By the time one recommends debridement, the wounds are usually at a serious, complex stage. Patients are often on anticoagulant therapy, making bedside debridement risky prior to the advent of effective hemostatic dressing options.

   Traditionally, surgeons performed sharp debridement in hospital operating rooms but more procedures are now taking place in the ambulatory setting.
   Until recently, many patients with coagulopathies or those on significant antithrombotic therapies could not get debridement in time to prevent further deterioration of necrotic tissue. They were either too sick to get clearance for the procedure in the OR or the procedure was too dangerous to execute at the bedside. Bedside debridements are an ideal option for debilitated patients but the procedure was often discouraged due to the risk of hemorrhaging outside of the OR’s controlled setting. Effective hemostatic bandages now solve this problem.

   The availability of chitosan-based hemostatic dressings allow for safe, effective and thorough debridement of necrotic chronic wounds in an ambulatory setting or for inpatients at the bedside. This improves patient safety and wound care. The bandages are ideal for wounds that are prone to acute bleeding after mechanical and surgical debridement, and quickly stop a wide range of bleeding, from oozing to severe arterial bleeds.

How Do Chitosan-Based Hemostatic Dressings Work?

   In regard to chitosan-based hemostatic wound dressings, chitosan is a naturally occurring biocompatible and biodegradable polysaccharide derived from chitin, the structural element in the exoskeleton of crustaceans. Chitosan-based bandages control hemostasis and stop bleeding within minutes. The bandages’ antibacterial barrier properties may also help prevent infection at the incision site.

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