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Amputation Prevention in Black Populations: Wound Debridement Strategies

Open wounds, from ulcerations to slow-healing wounds, are some of the comorbidities in diabetic patients that lead to lower limb amputation. Foot ulceration precedes 85% of diabetes-related amputations. The Black population, in particular, has a 77% higher risk of diabetes than the rest of the U.S population. Wound debridement is one strategy used to promote wound healing to reduce amputation. Let's dive in and find out more about wound debridement strategies.

What Is Wound Debridement?

Wound debridement removes dead or infected tissue to help a wound heal. It minimizes scarring, helps healthy tissue grow, and reduces complications of infections. Wound debridement is crucial for wounds that are getting worse and allows the healing process to begin.

Non-healing Wounds in Diabetics

Foot ulceration is a leading cause of non-traumatic minor and major lower limb amputations. A small wound on the foot can quickly develop into a foot ulcer, which tends to heal more slowly and progress quickly.

If left untreated, a foot ulcer can lead to limb loss. For this reason, an optimal way to close and heal wounds quickly is required. Besides, timely catching of wounds is the only way to reduce complications.

Conditions that arise from diabetes, such as neuropathy and pulmonary artery disease (PAD), are some of the major contributors to non-healing wounds. Diabetic neuropathy is damage to the nerves in the limbs. A patient suffering from neuropathy may not be able to feel ulcers when they occur, causing the wounds to become even more severe.

PAD reduces the supply of oxygen and blood platelets in the repair process. This lack of blood flow leads to rapid tissue death and impedes wound healing. Also, elevations in blood glucose can reduce the body's ability to fight off a potential infection and slow healing.

Wound Debridement Strategies

Wound debridement is required for old, non-healing wounds that worsen by the day. Healthcare providers use a combination of debridement methods, but this greatly depends on the wound, patient age, risk of complications, and overall health.

Mechanical Debridement

Mechanical debridement is the most common wound debridement type, and it removes tissue using a moving force. This wound debridement strategy is ideal for both infected and non-infected wounds. Examples of mechanical debridement include:

  • Hydrotherapy – uses running water to wash away old tissue using a whirlpool bath, syringe, catheter tube, or shower treatment.
  • Wet-to-dry dressing – promotes moist wound healing and removes dead tissue from wounds once it dries and sticks to the wound.

Biological Debridement

Doctors use maggots from Lucilla sericata (green bottle fly) grown in sterile environments for biological debridement. The maggots are applied to the wound bed in a mesh and placed with the dressing. They then eat old tissue, allowing the wound to heal and help control infections by releasing antibacterial substances.

Biological debridement is also known as biosurgery, larval therapy, or maggot debridement therapy. This wound debridement strategy is often used for large wounds or to combat antibiotic-resistant bacteria in the wound site. Custom and pre-assembled dressings are available, plus the option to create your own.

Enzymatic Debridement

Enzymatic or chemical debridement involves applying a prescribed topical gel or ointment that liquefies necrotic tissues with enzymes. This medication is applied one to two times a day, after which the wound is dressed. This method is done together with surgical and sharp debridement. Enzymatic debridement is commonly used for long-term care since there is less pain. It, however, cannot be used on chronic wounds.

Autolytic Debridement

Autolytic debridement is a strategy that relies on the body's immune cells, enzymes, and moisture to liquefy and eliminate necrotic tissue. A moisture-retention dressing is placed on the sores to create an environment for digestion of devitalized tissues. Maintaining a balance in moisture is essential. Autolytic debridement is painless for the patient and is ideally used for non-infected wounds and pressure sores.

Sharp Debridement (Conservative and Surgical)

Conservative sharp debridement uses forceps, scalpels, scissors, or curettes to remove biofilm and devitalized tissue. This debridement method doesn't extend to the surrounding healthy tissue and is performed by a doctor, nurse, podiatrist, or dermatologist.

Surgical sharp debridement is done when all other debridement methods fail. It involves direct removal of necrotic tissues using surgical instruments to assess wound depth and severity. The limitation of this surgery is that it's non-selective, and the surgeon may remove healthy tissue around the wound. Surgical sharp debridement is often used for chronic wounds and is the most efficient method for wound bed preparation.

Debridement Wound Care

To prevent further complications, always take care of your wound. Some of the recommended daily practices for effective wound healing include:

  • Regularly changing the dressing,
  • Keeping the wound clean, and
  • Reducing pressure on the wound.

Maintain a balanced diet since the nutrients improve the body's immunity and encourage wound healing. Avoid smoking as it stops nutrients and oxygen from reaching the wound, ultimately worsening the ulcer. Regular checkups at the doctor's office also ensure proper wound healing.

Bottom Line

Wound debridement is necessary for wounds that are getting worse. The Black population needs to understand the numerous debridement options available at their disposal. This way, treatment for non-healing sores is done promptly to prevent unnecessary amputations among African Americans.

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