The Importance and Limits of the Pres­sure Ulcer Surgical Debridement

Summary

Pressure ulcers are skin and soft tissue lesions appearing in over-pressured places of the body. According to EPUAP/ NPUAP classification, the presence of necrosis is a basic condition for determining the third and fourth stage of pressure ulcers. Necrotic tissue on the wound impedes the healing process and granulation tissue formation and is a source of infection and malodour. It poses a serious wound bioburden. Removal of the necrosis (necrectomy) and pressure ulcer bed debridement are important steps in a wound bed preparation (TIME concept). In practice, presence of moist necrosis (slough) is often being connected with presence of a wound infection, whereas dry gangrene (eschar) obstructs wound healing far less, and non-infected eschar can in some cases serve as a temporary pressure ulcer covering. Proper timing of debridement together with selectionof a correct debridement method noticeably affects treatment results. Despite of the well-known advantages, debridement can sometimes disrupt the healing process: over-excision leads to removal of the necrosis and even of the vital tissue close to the necrosis; debridement methods causing wound trauma (scissors, electrocautery) remove deficient tissues as well as they disrupt the wound bed vitality. Our research consisted of two parts: experimental (on a tissue model) and clinical part (on a group of probands). We have shown that sharp (scalpel) and hydrosurgical debridement (Vestajet) speed up the debridement process and shorten the total time for tissue recovery.

Key words:
debridement – pressure ulcer – necrectomy

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.