Pertinent Insights On Effective Debridement Tools

Author(s): 
Clinical Editor: Kazu Suzuki, DPM, CWS

   Although Dr. Bell has not yet used ultrasound debridement in his practice, he expresses curiosity as ultrasound “appears to be an excellent clinical modality.”

Q:

What are your favorite non-surgical wound debridement methods?

A:

Dr. Suzuki’s non-surgical debridement agent of choice is collagenase (Santyl ointment, Healthpoint Biotherapeutics).

   “It is virtually painless and much more effective and consistent than simple autolytic debridement using occlusive dressings,” maintains Dr. Suzuki.

   Since one will usually treat a few patients who cannot tolerate the pain of sharp debridement, Dr. Suzuki would prescribe such patients Santyl, which they would apply daily to the wounds between their office visits or during hospital stays. For these patients, he would also provide minimal sharp debridement and non-contact ultrasound debridement for their follow-up visits.

   Although the modalities are not advertised as debridement tools, Dr. Suzuki believes medical-grade topical honey and topical cadexomer iodine products have some debriding properties besides their antimicrobial properties. Therefore, he may use Medihoney (Derma Sciences), Iodosorb and Iodoflex (Smith and Nephew) for debridement of infected wounds.

   Although Dr. Armstrong says enzymatic therapy can be helpful in what his SALSA group calls “wound hospice” patients (when the primary goal may be to keep the wound clean but not necessarily to heal it), he says enzymatic therapy is not a substitute for surgical debridement.

   Dr. Bell’s favorite non-surgical debridement tool is the Versajet as cited above.

Q:

Do you use maggots or any other topical methods to debride wounds?

A:

Calling himself a “larvaphile,” Dr. Armstrong has used maggots for many years.

   “Our non-human colleagues are quite adept at bridging the gap between surgical debridements and in assisting in wound hospice,” notes Dr. Armstrong.

   Likewise, Dr. Suzuki thinks maggots are very useful for infected or non-infected wounds. Similar to collagenase, maggots are mostly painless so he will use maggot therapy for a few patients who absolutely cannot tolerate the wound debridement due to pain or their critical medical conditions (as in ICU patients). The only drawback is the cost, which Dr. Suzuki estimates at about $100 per vial of medical maggots, which will provide 48 hours of debridement.

   Dr. Bell has not had the opportunity to use the larvae of Lucilia sericata (the green bottle fly). He notes this method of debridement is selective as the larvae only ingest necrotic tissue. Maggot debridement can be beneficial in a setting where debridement is needed yet severe underlying arterial compromise is a concern, according to Dr. Bell. He says maggot debridement also may be beneficial in settings where management of the wound is not under the care of a surgically trained provider.

   As for other methods of debridement, Dr. Bell has extensively used enzymatic debridement and lavage debridement as well as primary dressings such as hydrogels and alginates to promote autolytic debridement. He advises considering a number of factors to determine what debridement modalities one will use.

   Dr. Armstrong is a Professor of Surgery at the University of Arizona College of Medicine in Tucson, Ariz. He is the Director of the Southern Arizona Limb Salvage Alliance (SALSA).

   Dr. Bell is a board certified wound specialist of the American Academy of Wound Management and a Fellow of the American College of Certified Wound Specialists. He is the founder of the “Save a Leg, Save a Life” Foundation, a multidisciplinary, non-profit organization dedicated to the reduction of lower extremity amputations and improving wound healing outcomes through evidence-based methodology and community outreach.

   Dr. Suzuki is the Medical Director of the Tower Wound Care Center at the Cedars-Sinai Medical Towers. He is also on the medical staff of the Cedars-Sinai Medical Center in Los Angeles and is a Visiting Professor at the Tokyo Medical and Dental University in Tokyo, Japan.

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