WOUND DEBRIDEMENT
Possible Complications
Debridement is the removal of unhealthy tissue from a wound to promote healing. It can be done by surgical, chemical, mechanical, or autolytic (using your body's own processes) removal of the tissue.
Complications
are rare, but no procedure is completely free of risk. If you are having a debridement, your doctor will review a list of possible complications which may include: y
Pain
y
Bleeding
y y y
Infection Delayed healing Removal of healthy tissue with mechanical debridement
Factors that may increase the risk of complications include: y y y y y
y y
Reasons for Procedure Debridement is used to clean dead and contaminated material from your wound to aid in healing. The procedure is most often done for the following reasons:
y
Prior to Procedure y y y
y
y
y
y
To remove tissue contaminated by bacteria, foreign tissue, dead cells, or crusting To create a neat wound edge to decrease scarring To aid in the healing of very severe burns or pressure sores (decubitus ulcers) To get a sample of tissue for testing and diagnosis
Infection Pre-existing medical conditions Smoking Diabetes Use of steroid or other immunosuppressive medicines Poor nutrition Poor circulation Immune disorders
Physical
exam Take a measurement of the wound Provide pain medicine before changing debridement dressings (for nonsurgical procedures)
DESCRIPTION OF PROCEDURE The following four methods are often used in combination: Surgical Debridement Surgical
debridement is done using scalpels, forceps, scissors, and other instruments. It is used if your wound is large, larg e, has deep tissue damage, or if your wound is especially painful. It may also be done if debriding your wound is
urgent. The skin surrounding the wound will be cleaned and disinfected. The wound will be probed with a metal instrument to determine its depth and locate any foreign matter. The doctor will cut away dead tissue. The wound
BURNS
will be washed out to remove any free tissue. In some cases, transplanted skin may be gr afted into place. Sometimes, cutting away the entire contaminated wound may be the most effective treatment. Chemical Debridement A debriding medicine will be applied to your wound. The wound will be covered with a dressing. The enzymes in the medicine will dissolve the dead tissue in the wound.
THERE ARE THREE LEVELS OF BURNS: y
Mechanical Debridement Mechanical debridement can involve a variety of methods to remove dead or infected tissue. It may include using a whirlpool bath, a syringe and catheter, or wet to dry dressings. Wet to dry dressing starts by applying a wet dressing to your wound. As this dressing dries, it absorbs wound material. The dressing is then remoistened and removed. Some of the tissue comes with it. Autolytic Debridement This form of debridement uses dressings that retain wound fluids that assist your body's natural abilities to clean the wound. This type of dressing is often used to treat pressure sores. This process takes more time than other methods. It will not be used for wounds that are infected or if quick treatment is needed. It is a good treatment if your body cannot tolerate more forceful treatments.
y
y
First-degree burns affect only the outer layer of the skin. They cause pain, redness, and swelling. Second-degree (partial thickness) burns affect both the outer and underlying layer of skin. They cause pain, redness, swelling, and blistering. Third-degree (full thickness) burns extend into deeper tissues. They cause white or blackened, charred skin that may be numb.
CONSIDERATIONS Before
giving first aid, evaluate how extensively burned the person is and try t o determine the depth of the most serious part of the burn. Then treat the entire burn accordingly. If in doubt, treat it as a severe burn. By
giving immediate first aid before professional medical help arrives, you can help lessen the severity of the burn. Prompt medical attention to serious burns can help prevent scarring, disability, and deformity. Burns on the face, hands, feet, and genitals can be particularly serious.
Children
under age 4 and adults over ag e 60 have a higher chance of complications and death from severe burns. CAUSES y
y
y
y
Symptoms Of An Airways Burn Burns
can be caused by dry heat (like fire), wet heat (such as steam or hot liquids), radiation, friction, heated objects, the sun, electricity, or chemicals. Thermal burns are the most common type. Thermal burns occur when hot metals, scalding liquids, steam, or flames come in contact with your skin. These are frequently the result of fires, automobile accidents, playing with matches, improperly stored gasoline, space heaters, and electrical malfunctions. Other causes include unsafe handling of firecrackers and kitchen accidents (such as a child climbing on top of a stove or grabbing a hot iron). Burns to your airways can be caused by inhaling smoke, steam, superheated air, or toxic fumes, often in a poorly ventilated space. Burns in children are sometimes traced to parental abuse.
SYMPTOMS y
Blisters
y
Pain
y y y
y y
(the degree of pain is not related to the severity of the burn -- the most serious burns can be painless) Peeling skin Red skin Shock (watch for pale and clammy skin, weakness, bluish lips and fingernails, and a drop in alertness) Swelling White or charred skin
y
C harred mouth; burned lips
y
Burns
y y y y y
on the head, face, or neck Wheezing C hange in voice Difficulty breathing; coughing Singed nose hairs or eyebrows Dark, carbon-stained mucus
DO NOT y
y
y y
y
y
y
Do NOT apply ointment, butter, ice, medications, cream, oil spray, or any household remedy to a severe burn. Do NOT breathe, blow, or cough on the burn. Do NOT disturb blistered or dead skin. Do NOT remove clothing that is stuck to the skin. Do NOT give the person anything by mouth, if there is a severe burn. Do NOT immerse a severe burn in cold water. This can cause shock. Do NOT place a pillow under the person's head if there is an airways burn. This can close the airways.
