A clean woundbed is essential for proper healing of any wound.
There are 3 factors that can delay or prevent the achievement of a clean woundbed. • Necrosis • Bioburden • Exudate
Remove necrotic tissue
Removing necrotic or sloughy tissue is an essential step in woundbed preparation. In the presence of necrosis it can be difficult to accurately assess the wound. Necrotic tissue can harbour micro-organisms, as well as being a physical barrier to healing.
Removal of necrotic tissue, or debridement, can be achieved in a number of ways. • Surgical • Enzymatic • Autolytic • Mechanical
Choosing an appropriate method of debridement should take into account the general health of the patient, the size and type of wound, the likely outcome and the pain management options available. It may be appropriate to use more than one type of debridement method.
Infection is the most serious disorder of wound healing. It can be caused by any number of micro-organisms that invade the wound and multiply.
Infection is a complex process, influenced by many factors. • Type, pathogenicity, virulence and number of micro-organisms involved. • Age, genesis and condition of the wound. • Local defence mechanisms. • General immune status.
The presence of micro-organisms within a wound, in addition to the actual biological burden of additional cells, results in the presence of toxins and host cell defences that can impede wound healing. Removal of the resulting purulent, sloughy material is thus for effective wound healing.
Wound exudate can impair the granulation process, leading to maceration at the wound edges and delayed healing. Effective removal of exudate from the wound surface supports the wound healing process.
In chronic wounds exudate slows down or blocks the proliferation of cells that are important in the repair process. Wound exudate also contains substances that can break down or damage essential extracellular matrix materials, and inhibit growth factors, which are essential for optimal wound healing.
