This course will teach you how to perform surgical (or sharp) debridement of an acute, traumatic wound in order to allow wound healing to occur and prevent the development of an infected or chronic wound. View the full course for free here: [ Ссылка ]

Surgical Objectives Traumatic Wound Debridement:
The objective of wound debridement is to remove all foreign and devitalized tissue from the wound bed to promote healing. Foreign bodies and devitalized tissue (in particular, necrotic tissue) serve as a medium for bacterial growth, prolongs the inflammatory response, and prevents angiogenesis, granulation tissue formation, and epidermal resurfacing necessary for wound healing to occur. Dead or devitalized tissue also impedes wound contraction, prevents topical compounds from contacting the wound bed, and can obscure the extent and severity of a wound from the clinician. The principles of surgical debridement, although similar, differ somewhat between those related to an acute, traumatic wound, and the debridement of a chronic wound.

How to perform surgical (acute) wound debridement:
Debridement of an acute wound is focused on timely cleaning, removal of debris, and excision of devitalized tissue in order to allow healing to occur and prevent complications, such as infection. Complex or deep injuries may warrant collaboration between various surgical specialties or may necessitate surgical reconstruction.

Chronic wound debridement:
A chronic wound develops when a wound becomes stalled in the inflammatory phase of healing: the most common cause of this is infection. The concept of “wound bed preparation” highlights debridement as a critical step in transforming a chronic wound into an acute wound to stimulate healing or prepare the wound for grafting. Debridement of chronic wounds is influenced, in particular, by the quality of the vascular supply of the wound and surrounding area, as well as other vascular and healing-related patient factors including diabetes, smoking status, and immunosuppression. In certain cases of dry gangrene, specific anatomical areas (such as the digits) are sometimes left to autoamputate. In cases of wounds with underlying arterial insufficiency, alternative procedures including revascularization should be considered first and realistic treatment goals reached in collaboration with the relevant specialties. In terminal illness, invasive debridement may also not be inappropriate. In order to promote continuous wound healing, it may be necessary to consider alternative or staged methods of debridement once the initial removal of devitalized tissue has been achieved. A multidisciplinary approach is generally indicated. Non-surgical wound debridement can be performed in a number of ways. Autolytic debridement works on the principle of enhancing the natural process of selective liquefaction, separation, and digestion of necrotic tissue through the use of moisture-retaining dressings such as hydrogels and hydrocolloids. Biological debridement (larval therapy) uses maggots to remove devitalized tissue from wounds. Mechanical debridement involves the use of non-discriminatory physical force to remove necrotic tissue and debris from the wound surface, such as through pulsed lavage, ultrasound, and irrigation. Wet-to-dry dressings, where a saline-moistened gauze is allowed to dry on the wound and then is physically ripped off, were previously used as a standard mechanical debridement technique; however, this nonselective form of debridement is now rarely used as first-line therapy as it can damage viable tissue and can be extremely painful.

APPROACHES
A distinction is sometimes made between surgical and sharp debridement: surgical debridement requiring more extensive debridement (excision or wide resection of necrotic tissue) and the use of general anesthesia. Sharp debridement (sometimes also referred to as conservative sharp debridement) can generally be performed at the bedside or in an outpatient setting and is commonly performed by a range of different healthcare professionals, using a sterile scalpel, scissors, or both, to remove devitalized or foreign material from and around the wound to expose healthy tissue. In this course, surgical and sharp debridement are considered together.

Specific attention is paid to the following hazards you may encounter:
- Damage to healthy tissue through over-resection
- Severe wound contamination
- The following tips are designed to improve your performance:
- Cleaning technique
- Devitalized tissue recognition
- Nontraumatic grasping of tissue
- Management of high-velocity wounds
- Management of wound defect

After studying the course, you should be familiar with the following complications:
- Incomplete debridement risking the development of an infected or chronic wound
- Overexcision of wound causing damage to healthy tissue

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