Current And Emerging Modalities In Wound Debridement
- Volume 26 - Issue 8 - August 2013
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Super-oxidized solution is a hypotonic solution that contains hypochlorous acid, sodium hypochlorite, chlorine dioxide, ozone, hydrogen peroxide and sodium chloride. Super-oxidized solution is an electrochemically processed aqueous solution manufactured from pure water and sodium chloride. Reactive species of oxygen and chlorine (which have formed via electrolysis) create an unbalanced osmolarity. This disparity in osmolarity subsequently causes damage to the integrity of the cell membrane and then reacts and denatures the lipids and proteins of single cell organisms. This is a direct result of the osmolarity difference between the ion concentrations of the solution and single cell organism.
Multicellular organisms are not prone to such osmolarity changes, which is why these solutions are safe to use on the wound. An example of a super-oxidized solution would be Microcyn (Oculus Innovative Services).
Polyhexanide is a positively charged polymer that works against negatively charged microorganisms. It is able to penetrate slough and bioburden to stimulate wound healing. Polyhexanide is able to lower wound surface tension, which then supports the physical removal of debris and bacteria from the wound bed. It also has excellent antimicrobial properties, which makes the modality useful for surgical prep. One product example would be B Braun Medical’s Prontosan Wound Irrigation Solution and Wound Gel with Polyhexanide.
As wound care continues to evolve, the wound care specialist will be looking for ways to avoid excessive debridement. Regardless of the reason, iatrogenic trauma to the wound due to overly aggressive debridement cannot continue. We have to take responsibility. We cannot let fee for service, lack of training or being in a rush cause actions that result in the delay of wound healing. In the future, there may be tests that can determine if the ulcer has had adequate debridement.
Products like DermaPACE and the Qoustic device give us new tools to stimulate wound healing without the trauma of sharp debridement. One should consider alternative methods to sharp surgical debridement when the wound bed is covered in fibrin or slough, or if the wound is of partial thickness and the wound edges are not clearly demarcated.
Debridement is only a portion of the equation for a wound to heal and a multidisciplinary team approach is essential for wound healing. Without proper nutrition, effective management of comorbidities, control of any infection and providing for adequate vascularity, the wound cannot function properly. Until we restore this delicate balance, the wound will not heal. The aggressive implementation of offloading devices, the timely application of the “best” wound dressings that can absorb exudate and the appropriate use of biologics to stimulate wound healing are key elements to restore this balance and facilitate an environment for wound healing.
Dr. Belken is in private practice at Foot Healthcare Associates in Michigan. He is an Associate of the American College of Foot and Ankle Surgeons.
Dr. Mozen is in private practice at Foot Healthcare Associates in Michigan. He is a Diplomate of the American Board of Podiatric Surgery and a Fellow of the American College of Foot and Ankle Surgeons.