Pertinent Insights On Effective Debridement Tools
When considering which methods of wound debridement will be effective in their patients, clinicians have a wide range of choices at their disposal. These expert panelists discuss their preferences for sharp debridement, ultrasound debridement, non-surgical debridement and the use of maggots.
What are your favorite sharp debridement tools of your choice and why?
Kazu Suzuki, DPM, CWS, prefers using a 4 mm diameter disposable sharp curette by Miltex. It has a sharp edge that loops around and he says dermatologists often use the curette to remove small benign skin lesions. Dr. Suzuki finds the curette to be the “perfect tool” to debride most wounds. He notes that one can bend the blade tip by hand to turn it into various shapes (blunt or sharp) to match the size and shape of the wounds.
David G. Armstrong, DPM, MD, PhD, also finds that certain large curettes work well at debriding the central area of wounds. Desmond Bell, DPM, CWS, notes that curettes work very well to remove slough. He also says curettes can effectively debride areas of tunneling and undermining as well as remove biofilm from a relatively clean wound base.
Dr. Suzuki and Dr. Bell both use disposable #10 and #15 blades. Dr. Bell prefers to perform debridement with sharp surgical instruments since sharp debridement provides a highly selective manner to remove non-viable tissue. Additional benefits of surgical debridement include rapid conversion of the wound from chronic to acute and facilitating an immediate clinical assessment of perfusion, according to Dr. Bell. Dr. Bell prefers a #10 blade when he needs more extensive removal of necrotic tissue and a #15 blade when he needs to debride a smaller area or for finer removal of tissue.
In addition, Dr. Suzuki will use regular, non-disposable surgical instruments, forceps and scissors. He notes the non-disposable instruments are plastic surgery fine grade instruments that do not traumatize the skin edges. Dr. Suzuki says cheap disposable instruments can crush the skin’s edge.
All three panelists use the Versajet (Smith and Nephew). Dr. Suzuki uses the high-speed “water scalpel” in the operating room for debriding large wounds. As Dr. Bell explains, hydrosurgery utilizes the “Venturi effect,” which allows water to circulate in such a fashion that it produces a cutting effect on non-viable tissue. He says this method allows a suctioning effect as well and when one utilizes in it the OR setting, “the Versajet can dramatically reduce surgical time while performing its primary task exceptionally.” Dr. Suzuki concurs. Since Versajet combines debridement and saline irrigation in one hand-piece, Dr. Suzuki says it effectively cuts the OR time in half.
Do you use ultrasound debridement devices in your practice?
In his clinic, Dr. Armstrong has access to several ultrasonic debridement devices including the Qoustic Wound Therapy System (Arobella Medical) and SonicOne (Misonix). Although ultrasonic devices debride wounds more slowly than a curette or the Versajet, he says ultrasound may be more effective at breaking up biofilm.
Dr. Suzuki has also been using the Qoustic for more than three years. Similar to Versajet, ultrasound devices combine debridement and irrigation while delivering therapeutic ultrasound to the wound bed to fragment non-viable tissues and kill bacteria, according to Dr. Suzuki.
“I use the Qoustic system on almost every patient I see in our wound care center and I cannot imagine practicing wound care without it,” he says.
As for billing, since he does not yet have the specific CPT codes for ultrasound debridement and therapy, Dr. Suzuki just bills the services under sharp debridement codes (see the sidebar “What You Should Know About Debridement Coding Changes” on page 30 of the July 2011 issue).