Debridement solutions are essential

The Lohmann & Rauscher symposium “Debridement in daily practice – our options” took place last Thursday, May 4th 2017, during the 27th conference of the European Wound Management Association (EWMA) in Amsterdam. In four presentations chaired by Susan Lemson, international speakers stressed the importance of wound debridement and provided insights into the day-to-day practice of wound management in light of the latest findings from studies.

All those who attended the symposium “Debridement in daily practice – our options” initiated by Lohmann & Rauscher (L&R) agreed: debridement, i.e. the removal of bacteria, biofilm, and damaged or dead tissue from chronic wounds, is an essential treatment method. At the start of wound treatment it plays a key role in supporting the wound healing. 

The best debridement method is selected for a particular patient and his or her wounds to ensure administration of treatment that is appropriate for both patient and wounds. In particular, the pain that often occurs during debridement should be reduced by selecting a suitable debridement method. For this reason, the four speakers explained to their audience why the correct use of debridement is so important as the first step in wound treatment and how it can promote the wound healing.

Debridement in the day-to-day practice

In her presentation “Debridement in the day-to-day practice” the Dutch vascular surgeon Susan Lemson from Slingeland Hospital in Doetinchem discussed various methods of debridement used in routine practice. For the relevant specialists, autolytic and mechanical methods of debridement using monofilament fibre pads are the easiest to use and are readily accepted by patients because of the likelihood of pain-free treatment. In each case, debridement is the first crucial step in wound treatment because new tissue does not form readily on debris, pus and fibrin coatings or necroses. That is why the basic principle is “Only a clean wound can heal”. Which method is ultimately the best, depends on the particular situation of the patient (e.g. nature of the debris, pus, necrosis, location of the wound etc.). Consequently, the appropriate choice usually requires a case-by-case decision made by the local treatment provider.

Wound Debridement – a report from the front line

Vascular surgeon Dr Gunnar Riepe (Gemeinschaftsklinikum Mittelrhein/Germany) reported “from the front line” about his debridement experience in his routine clinical practice. In his presentation he stressed the importance of debridement as the starting point for good wound healing. Because wound debridement is not used enough by many practitioners, he also outlined various options that can be used to increase appreciation of the importance of debridement among patients and practitioners. Through interaction and integration of all the parties involved (doctors, nurses, relatives and the patients themselves) during day-to-day wound treatment, it is possible to achieve very good therapeutic results. This also leads to an increase in patient compliance. Debridement tools involving less pain – such as the monofilament fibre pad, presented in a case study of 170 patients – as well as more economic and simpler procedures make debridement more tolerable, feasible and financially viable.

The management of chronic wound biofilm with a debridement pathway

Richard Shorney, Managing Director of Real Healthcare Solutions in Northwich/England, discussed the rising costs for the treatment of chronic wounds over the coming years in his presentation. According to Shorney, these will amount to about 5,300 million pounds in Great Britain alone. Many wounds heal only very slowly because of the development of a biofilm, a thin mucous film containing populations of a wide variety of pathogenic micro-organisms. For this reason, he advises treating these wounds with Debrisoft®, a monofilament fibre pad. To support his recommendation, Shorney referred to a 2016 survey involving almost 2,000 participants, specialists and patients: generally, the patients were very satisfied with their treatment with Debrisoft®, which provides a suitable, safe and effective possibility for wound bed preparation and biofilm-based wound management. By combining Debrisoft® with antimicrobial wound dressings (e.g. with polyhexanide) after debridement, the biofilm can be reduced significantly and any “flare ups” can be suppressed.

The real value of mechanical debridement in assessment of chronic wounds

According to Sara Sandroni, Senior Nurse Manager and technical coordinator at the Azienda USL hospital in Tuscany (Italy), debridement is an essential foundation for wound healing, particularly for chronic wounds such as venous ulcers, decubitus ulcers or diabetic foot syndrome. The mechanical method – using monofilament fibre pads or in the case of deeper wounds also with the Lolly – has numerous advantages for the patient, especially in the home environment – particularly with regard to user friendliness, tolerability and clinical debridement effect. As evidence, she refers to a study carried out within her area: 80 patients from her wound network with chronic wounds were treated at home with either autolytic, enzymatic or monofilament fibre products. Compared to the other two methods, the monofilament fibre products produced a much clearer improvement in the wound bed. This consequently optimises the management of resources and material, from both an economic perspective and the patient’s comfort – their quality of life. This is associated with advantages for all those involved: users, relatives and patients.