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WOUND DEBRIDEMENT
JCN supplement
2018,Vol 32, No 4
11
fibres, enabling the wound bed to
prepare for healing (Downe, 2014).
The physical act of using the cloth
on a wound, along with the active
ingredients in the UCS cloths, provide
an optimum debridement solution.
The UCS cloth is premoistened
with active ingredients containing a
surfactant, a mild keratolytic and aloe
vera. UCS is a class IIb medical device,
and is therefore safe for use in deep
wounds where there may be exposed
bone. Surfactants are cleansers that
penetrate the surface of a wound,
providing deep and effective cleansing
in just a few minutes.
Percival and Suleman (2015)
proposed that best practice for slough
removal should include the use
of surfactants to disrupt the outer
membrane of sloughy tissue. The
surfactants used in UCS are gentle,
non-allergenic cleansers, which
are non-cytotoxic and so cause no
harm to healthy tissue or cells. The
mild keratolytic helps to soften any
hardened skin or dry necrotic tissue
and eschar, allowing it to lift away
and shed (Gillies, 2016). The addition
of the solution to the mechanical
debridement aspect of the cloth is key
in its efficacy (Percival et al, 2017).
WOUND ASSESSMENT
While assessment is important in
the decision to debride, there are
also occasions where debridement
is needed to be able to fully assess a
wound. Weir et al (2007) identified
that devitalised tissue needs to be
removed to enable visibility of the
wound bed. Since Guest et al’s (2015)
seminal health economics study and
NHS England including‘improving
the assessment of wounds’as a
key goal of the Commissioning for
Quality and Innovation (CQUIN)
framework scheme for 2017–2019
(NHS England, 2016), wound
assessment has been at the top of
wound care priorities.
Indeed, accurate assessment
is key to ensure correct diagnosis
and development of the optimal
treatment plan (Chamanga,
2016). The preliminary step in the
assessment process should be to
ensure that the wound and any
surrounding skin are clean to enable
a true picture of the wound to be
obtained (Downe, 2014). This not
only enables clinicians to assess
the size, depth, and location of the
wound accurately, but also to identify
the tissue types present, which will
help in monitoring wound progress
and choosing appropriate dressings
(Downe, 2014).
WOUND BED PREPARATION
When managing chronic wounds,
a structured approach to wound
bed preparation, such as the
TIME acronym (tissue, infection/
inflammation, moisture/moisture
imbalance, and wound edges) is
recommended (Schultz et al, 2003).
Debridement plays a key role in
all areas of the TIME framework
(European Wound Management
Association [EWMA], 2013), i.e:
Tissue: debridement of non-viable
or wound debris from
the wound
Infection/inflammation:
debridement reduces the bacterial
burden within a wound and
controls ongoing inflammation
(Ousey et al, 2016)
Moisture imbalance: debridement
can assist in wound exudate
management by decreasing excess
moisture (EWMA, 2013)
Edge of wound: debridement can
assist in removing senescent cells
and encouraging advancement of
wound edges (Cornell et al, 2010).
To achieve an acceptable rate of
healing, wounds must be properly
cleansed and debrided (Milne, 2015).
However, it can be difficult to cleanse
wounds where pain is an issue.
The ability to allow the solution in
the UCS cloth to soften non-viable
tissue, which can then gently be
removed, is helpful in situations
where patients decline cleansing
due to pain (Khatun, 2016). The
cloths also allow patients to control
the level of pressure applied to the
wound, thereby reducing anticipatory
pain expectations (Khatun, 2016).
Case report one
This 83-year-old gentlemen who
presented with a venous leg ulcer to
the left medial malleolus (
Figure 1
)
had a history of venous insufficiency/
varicose eczema and a recent history
of infection and cellulitis. He had been
treated with antibiotics, which had
controlled exudate volume and odour,
but his wound remained necrotic with
evidence of biofilm and dry, non-
viable skin to the periwound area.
It was decided to use UCS
debridement cloth first to soften
the eschar and dry skin, and then
to debride the biofilm and necrotic
tissue, as well as exfoliating the
periwound skin. After just one
session, improvement could be seen
in both the condition of the wound
bed and periwound skin (
Figure
2
). Metal forceps and debridement
scissors were also used to trim areas
of attached skin, to prevent bleeding
or further ulceration
The patient’s pain level was
not an issue, but he did also have
a degree of neuropathy to his left
lower leg. The patient was happy
›
Facts...
The ingredients contained in UCS debridement cloths are:
Poloxamer 188: a surfactant. Surfactants are able to provide a ‘deep clean’
of tissues and wounds by breaking down the interface between water
and oils and/or bacteria. This action allows for deeper cleaning than that
provided by water
Allantoin: a mild keratolytic with moisturising properties, which causes the
skin’s keratin layer to soften. This property helps skin to heal quickly and to
bind moisture effectively, benefiting dry skin and helping to heal
the wound
Aloe vera barbadensis leaf extract: this comprises ingredients derived from
the various species of aloe vera for a soothing and moisturising effect with
no known side-effects.
(Khatun, 2016)