References

Wolcott RD, Kennedy JP, Dowd SE. Regular debridement is the main tool for maintaining a healthy wound bed in most chronic wounds. J Wound Care. 2009; 18:(2)54-56 https://doi.org/10.12968/jowc.2009.18.2.38743

Wolcott RD, Rumbaugh KP, James G Biofilm maturity studies indicate sharp debridement opens a time-dependent therapeutic window. J Wound Care. 2010; 19:(8)320-328 https://doi.org/10.12968/jowc.2010.19.8.77709

Rosenbaum AJ, Banerjee S, Rezak KM, Uhl RL. Advances in wound management. J Am Acad Orthop Surg. 2018; 26:(23)833-843 https://doi.org/10.5435/JAAOSD-17-00024

Percival SL, Hill KE, Williams DW A review of the scientific evidence for biofilms in wounds. Wound Repair Regen. 2012; 20:(5)647-657 https://doi.org/10.1111/j.1524-475X.2012.00836.x

Frykberg RG, Banks J. Challenges in the treatment of chronic wounds. Adv Wound Care. 2015; 4:(9)560-582 https://doi.org/10.1089/wound.2015.0635

Schultz GS, Sibbald RG, Falanga V Wound bed preparation: a systematic approach to wound management. Wound Repair Regen. 2003; 11:S1-S28 https://doi.org/10.1046/j.1524-475X.11.s2.1.x

Blanchette KA, Wenke JC. Current therapies in treatment and prevention of fracture wound biofilms: why a multifaceted approach is essential for resolving persistent infections. J Bone Jt Infect. 2018; 3:(2)50-67 https://doi.org/10.7150/jbji.23423

Block L, King TW, Gosain A. Debridement techniques in pediatric trauma and burnrelated wounds. Adv Wound Care. 2015; 4:(10)596-606 https://doi.org/10.1089/wound.2015.0640

Steed DL, Donohoe D, Webster MW, Lindsley L Effect of extensive debridement and treatment on the healing of diabetic foot ulcers. J Am Coll Surg. 1996; 183:(1)61-64

Türk EE, Tsokos M, Delling G. Autopsy-based assessment of extent and type of osteomyelitis in advancedgrade sacral decubitus ulcers: a histopathologic study. Arch Pathol Lab Med. 2003; 127:(12)1599-1602 https://doi.org/10.5858/2003-127-1599-AAOEAT

Whitney J, Phillips L, Aslam R Guidelines for the treatment of pressure ulcers. Wound Repair Regen. 2006; 14:(6)663-679 https://doi.org/10.1111/j.1524-475X.2006.00175.x

Hellebrekers P, Leenen LP, Hoekstra M, Hietbrink F. Effect of a standardized treatment regime for infection after osteosynthesis. J Orthop Surg Res. 2017; 12:(1) https://doi.org/10.1186/s13018-017-0535-x

Snyder RJ, Bohn G, Hanft J Wound biofilm: current perspectives and strategies on biofilm disruption and treatments. Wounds. 2017; 29:(6)S1-S17

Charlson ME, Pompei P, Ales KL, McKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: developement and validation. J Chronic Dis. 1987; 40:(5)373-383 https://doi.org/10.1016/0021-9681(87)90171-8

Termavasio-de la Vega HG, Castano-Romero F, Ragozzino S The updated Charlson comorbidity index is a useful predictor of mortality in patients with Staphylococcus aureus bacteraemia. Epidemiol Infect. 2018; 146:2122-2130 https://doi.org/10.1017/S0950268818002480

Cierny G, Mader JT, Penninck JJ. The classic: a clinical staging system for adult osteomyelitis. Clin Orthop Relat Res. 2003; 414:7-24 https://doi.org/10.1097/01.blo.0000088564.81746.62

Blanchette KA, Wenke JC. Current therapies in treatment and prevention of fracture wound biofilms: why a multifaceted approach is essential for resolving persistent infections. J Bone Jt Infect. 2018; 3:(2)50-67 https://doi.org/10.7150/jbji.23423

Mustoe TA., O'Shaughnessy Kloeters O. Chronic wound pathogensis and current treatment strategies: a unifying hypothesis. Plast Reconstr Surg. 2006; 117:(7S)35S-41S https://doi.org/10.1097/01.prs.0000225431.63010.1b

Bay L, Kragh KN, Eickhardt SR Bacterial aggregates establish at the edges of acute epidermal wounds. Adv Wound Care. 2018; 7:(4)105-113 https://doi.org/10.1089/wound.2017.0770

Falanga V. Classifications for wound bed preparation and stimulation of chronic wounds. Wound Repair Regen. 2000; 8:(5)347-352 https://doi.org/10.1111/j.1524475X.2000.00347.x

Bjarnsholt T, Kirketerp-Møller K, Jensen PØ Why chronic wounds will not heal: a novel hypothesis. Wound Repair Regen. 2008; 16:(1)2-10 https://doi.org/10.1111/j.1524-475X.2007.00283.x

Brown GS. Reporting outcomes for stage IV pressure ulcer healing: a proposal. Adv Skin Wound Care. 2000; 13:(6)277-283

Wolcott RD, Rumbaugh KP, James G Biofilm maturity studies indicate sharp debridement opens a time-dependent therapeutic window. J Wound Care. 2010; 19:(8)320-328 https://doi.org/10.12968/jowc.2010.19.8.77709

Yang Q, Phillips PL, Sampson EM Development of a novel ex vivo porcine skin explant model for the assessment of mature bacterial biofilms. Wound Repair Regen. 2013; 21:(5)704-714 https://doi.org/10.1111/wrr.12074

Anghel EL, DeFazio MV, Barker JC Current concepts in debridment: science and strategies. Plast Reconstr Surg. 2016; 138:82S-93S https://doi.org/10.1097/PRS.0000000000002651

Block L, King TW, Gosain A. Debridement techniques in pediatric trauma and burnrelated wounds. Adv Wound Care. 2015; 4:(10)596-606 https://doi.org/10.1089/wound.2015.0640

Falabella AF. Debridement and wound bed preparation. Dermatol Ther. 2006; 19:(6)317-325 https://doi.org/10.1111/j.1529-8019.2006.00090.x

Sassoon A, Riehl J, Rich A Muscle viability revisited: are we removing normal muscle? A critical evaluation of dogmatic debridement. J Orthop Trauma. 2016; 30:(1)17-21 https://doi.org/10.1097/BOT.0000000000000423

Parry JA, Karau MJ, Kakar S Disclosing agents for the intraoperative identification of biofilms on orthopedic implants. J Arthroplasty. 2017; 32:(8)2501-2504 https://doi.org/10.1016/j.arth.2017.03.010

Dorafshar AH, Gitman M, Henry G Guided surgical debridement: staining tissues with methylene blue. J Burn Care Res. 2010; 31:(5)791-794 https://doi.org/10.1097/BCR.0b013e3181eed1d6

Bohn GA, Schultz GS, Liden BA Proactive and early aggressive wound management: a shift in strategy developed by a consensus panel examining the current science, prevention, and management of acute and chronic wounds. Wounds. 2017; 29:(11)S37-S42

Ferrer-Sola M, Sureda-Vidal H, Altimiras-Roset J Hydrosurgery as a safe and efficient debridement method in a clinical wound unit. J Wound Care. 2017; 26:(10)593-599 https://doi.org/10.12968/jowc.2017.26.10.593

Liu J, Ko JH, Secretov E Comparing the hydrosurgery system to conventional debridement techniques for the treatment of delayed healing wounds: a prospective, randomised clinical trial to investigate clinical efficacy and cost-effectiveness. Int Wound J. 2015; 12:(4)456-461 https://doi.org/10.1111/iwj.12137

Madhok BM, Vowden K, Vowden P. New techniques for wound debridement. Int Wound J. 2013; 10:(3)247-251 https://doi.org/10.1111/iwj.12045

Placek J. Versajet: new technology for soft tissue debridement. Plast Surg Nurs. 2007; 27:(2)111-113 https://doi.org/10.1097/01.PSN.0000278245.31028.1c

James GA, Swogger E, Wolcott R Biofilms in chronic wounds. Wound Repair Regen. 2008; 16:(1)37-44 https://doi.org/10.1111/j.1524-475X.2007.00321.x

Skärlina EM, Wilmink JM, Fall N, Gorvy DA. Effectiveness of conventional and hydrosurgical debridement methods in reducing Staphylococcus aureus inoculation of equine muscle in vitro. Equine Vet J. 2015; 47:(2)218-222 https://doi.org/10.1111/evj.12284

Percival SL, Suleman L. Slough and biofilm: removal of barriers to wound healing by desloughing. J Wound Care. 2015; 24:(11)498-510 https://doi.org/10.12968/jowc.2015.24.11.498

Luedtke-Hoffmann KA, Schafer DS. Pulsed lavage in wound cleansing. Phys Ther. 2000; 80:(3)292-300 https://doi.org/10.1093/ptj/80.3.292

Wilcox JR, Carter MJ, Covington S. Frequency of debridements and time to heal: a retrospective cohort study of 312 744 wounds. JAMA Dermatol. 2013; 149:(9)1050-1058 https://doi.org/10.1001/jamadermatol.2013.4960

Kit assembly for complete wound treatment. US Patent 6,562,013 B1; May 13, 2003. https://patents.google.com/patent/US6562013B1/en

Maragakis LL, Cosgrove SE, Song X An outbreak of multidrug-resistant Acinetobacter baumannii associated with pulsatile lavage wound treatment. JAMA. 2004; 292:(24)3006-3011 https://doi.org/10.1001/jama.292.24.3006

Sönnergren HH, Strömbeck L, Aldenborg F, Faergemann J. Aerosolized spread of bacteria and reduction of bacterial wound contamination with three different methods of surgical wound debridement: a pilot study. J Hosp Infect. 2013; 85:(2)112-117 https://doi.org/10.1016/j.jhin.2013.05.011

Ho CH, Bensitel T, Wang X, Bogie KM. Pulsatile lavage for the enhancement of pressure ulcer healing: a randomized controlled trial. Phys Ther. 2012; 92:(1)38-48 https://doi.org/10.2522/ptj.20100349

Bergstrom N, Bennett MA, Carlson CE Treatment of pressure ulcers: Clinical Practice Guideline No. 15.Rockville, MD: US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. AHCPR Publication No. 95–0652;

Khanna A, Nelmes RT, Gougoulias N The effects of LIPUS on softtissue healing: a review of literature. Br Med Bull. 2009; 89:(1)169-182 https://doi.org/10.1093/bmb/ldn040

Yadollahpour A, Mostafa J, Samaneh R, Zohreh R. Ultrasound therapy for wound healing: a review of current techniques and mechanisms of actions. J Pure Appl Microbiol. 2014; 8:(5)4071-4085

Murphy CA, Houghton P, Brandys T The effect of 22.5 kHz low-frequency contact ultrasound debridement (LFCUD) on lower extremity wound healing for a vascular surgery population: a randomised controlled trial. Int Wound J. 2018; 15:(3)460-472 https://doi.org/10.1111/iwj.12887

Crone S, Garde C, Bjarnsholt T, Alhede M. A novel in vitro wound biofilm model used to evaluate low-frequency ultrasonic-assisted wound debridement. J Wound Care. 2015; 24:(2)64-72 https://doi.org/10.12968/jowc.2015.24.2.64

Granick MS, Paribathan C, Shanmugan M, Ramasubbu N. Direct-contact low-frequency ultrasound clearance of biofilm from metallic implant materials. Eplasty. 2017; 17

Granick M, Rubinsky L, Parthiban C Dispersion risk associated with surgical debridement devices. Wounds. 2017; 29:(10)E88-E91 https://doi.org/10.25270/wnds/2017.10.e88e91

Chang YJ, Perry J, Cross K. Low-frequency ultrasound debridement in chronic wound healing: a systematic review of current evidence. Plast Surg (Oakv). 2017; 25:(1)21-26 https://doi.org/10.1177/2292550317693813

Voigt J, Wendelken M, Driver V, Alvarez OM. Lowfrequency ultrasound (20–40 kHz) as an adjunctive therapy for chronic wound healing: a systematic review of the literature and meta-analysis of eight randomized controlled trials. Int J Low Extrem Wounds. 2011; 10:(4)190-199 https://doi.org/1177/1534734611424648

Serena T, Lee SK, Lam K The impact of noncontact, nonthermal, low-frequency ultrasound on bacterial counts in experimental and chronic wounds. Ostomy Wound Manage. 2009; 55:(1)22-30

Bekara F, Vitse J, Fluieraru S New techniques for wound management: a systematic review of their role in the management of chronic wounds. Arch Plast Surg. 2018; 45:(2)102-110 https://doi.org/10.5999/aps.2016.02019

Trial C, Brancati A, Marnet O, Téot L. Coblation technology for surgical wound debridement: principle, experimental data, and technical data. Int J Low Extrem Wounds. 2012; 11:(4)286-292 https://doi.org/1177/1534734612466871

Nusbaum AG, Gil J, Rippy MK Effective method to remove wound bacteria: comparison of various debridement modalities in an in vivo procine model. J Surg Res. 2012; 176:(2)701-707 https://doi.org/10.1016/j.jss.2011.11.1040

Haemmerle G, Duelli H, Abel M, Strohal R. The wound debrider: a new monofilament fibre technology. Br J Nurs. 2011; 20:S35-S42 https://doi.org/10.12968/bjon.2011.20.Sup2.S35

Yang Q, Larose C, Della Porta AC A surfactantbased wound dressing can reduce bacterial biofilms in a porcine skin explant model. Int Wound J. 2017; 14:(2)408-413 https://doi.org/10.1111/iwj.12619

Schultz GS, Woo K, Weir D, Yang Q. Effectiveness of a monofilament wound debridement pad at removing biofilm and slough: ex vivo and clinical performance. J Wound Care. 2018; 27:(2)80-90 https://doi.org/10.12968/jowc.2018.27.2.80

Bahr S, Mustafi N, Hättig P Clinical efficacy of a new monoflament fibrecontaining wound debridement product. J Wound Care. 2011; 20:(5)242-248 https://doi.org/10.12968/jowc.2011.20.5.242

Seo Y, Leon J, Park JD Diatom microbubbler for active biofilm removal in confined spaces. ACS Appl Mater Interfaces. 2018; 10:(42)35685-35692 https://doi.org/10.1021/acsami.8b08643

Seo Y, Leong J, Park JD Diatom microbubbler for active biofilm removal in confined spaces. ACS Appl Mater Interfaces. 2018; 10:(42)35685-35692 https://doi.org/10.1021/acsami.8b08643

Stewart PS. Biophysics of biofilm infection. Pathog Dis. 2014; 70:(3)212-218 https://doi.org/10.1111/2049-632X.12118

Rennie MY, Lindvere-Teene L, Tapang K, Linden R. Point-of-care fluorescence imaging predicts the presence of pathogenic bacteria in wounds: a clinical study. J Wound Care. 2017; 26:(8)452-460 https://doi.org/10.12968/jowc.2017.26.8.452

Jørgensen LB, Sørensen JA, Jemec GB, Yderstraede KB. Methods to assess area and volume of wounds - a systematic review. Int Wound J. 2016; 13:(4)540-553 https://doi.org/10.1111/iwj.12472

Moelleken M, Jockenhöfer F, Benson S, Dissemond J. Prospective clinical study on the efficacy of bacterial removal with mechanical debridement in and around chronic leg ulcers assessed with fluorescence imaging. Int Wound J. 2020; 17:(4)1011-1018 https://doi.org/10.1111/iwj.13345

Raizman R, Dunham D, Lindvere-Teene L Use of a bacterial fluorescence imaging device: wound measurement, bacterial detection and targeted debridement. J Wound Care. 2019; 28:(12)824-834 https://doi.org/10.12968/jowc.2019.28.12.824

Salvana J, Rodner C, Browner BD Chronic osteomyelitis: results obtained by an integrated team approach to management. Conn Med. 2005; 69:(4)195-202

Voigt J, Mosier M, Darouiche R. Systematic review and meta-analysis of randomized controlled trials of antibiotics and antiseptics for preventing infection in people receiving primary total hip and knee prostheses. Antimicrob Agents Chemother. 2015; 59:(11)6696-6707 https://doi.org/10.1128/AAC.01331-15

Scheuermann-Poley C, Wagner C, Hoffmann J The significance of biofilm for the treatment of infections in orthopedic surgery. Unfallchirurg. 2017; 120:(6)461-471 https://doi.org/10.1007/s00113-017-0361-y

Müller G, Kramer A. Biocompatibility index of antiseptic agents by parallel assessment of antimicrobial activity and cellular cytotoxicity. J Antimicrob Chemother. 2008; 61:(6)1281-1287 https://doi.org/10.1093/jac/dkn125

Willy C, Scheuerman-Poley C, Stichling M Importance of irrigation solutions and fluid with antiseptic effects in therapy and prophylaxis: update 2017. Unfallchirurg. 2017; 7:549-560 https://doi.org/10.1007/s00113-017-0375-5

Fleming A. The action of chemical and physiological antiseptics in a septic wound. Br J Surg. 1919; 7:(25)99-129 https://doi.org/10.1002/bjs.1800072508

Atkin L, Bucko Z, Montero EC Implementing TIMERS: the race against hard-to-heal wounds. J Wound Care. 2019; 28:S1-S50 https://doi.org/10.12968/jowc.2019.28.Sup3a.S1

Stiehl JB. Bacterial autofluorescence digital imaging guides treatment in Stage 4 pelvic pressure injuries: a preliminary case series. Diagostics. 2021; 11:(5) https://doi.org/10.3390/diagnostics11050839

Early wound bed preparation: irrigation and debridement

02 September 2021
20 min read
Volume 5 · Issue 4

Early wound bed preparation is management of the wound to enable endogenous healing or to facilitate advanced treatments. Irrigation and debridement are the standard initial treatments for dealing with hard-to-heal wound infections. Healing by secondary intention is likely in compromised hosts. Operative surgical sharp procedure identifies the dimensions of the infection, and removes necrotic debris and biofilm-forming bacteria. Hydrosurgery and jet lavage low pressure irrigation are standard adjunct debridement technologies. Recent microbiological studies suggest that daily treatment may be an optimal method to create normal physiological wound healing. Outpatient local sharp debridement, pulsatile irrigation, debridement monofilament sponges, low intensity ultrasound and newer technologies enable efficient treatment. This editorial considers the medical evidence regarding these technologies and the potential for clinical benefit.

Surgeons have identified early wound bed preparation as an initial strategy to deal with hard-to-heal wound infections. These infections have not healed after three months, and healing by secondary intention may be the optimal choice.1,2,3 As compared with acute wound healing, hard-to-heal wounds have a pro-inflammatory stimulus. This is related to the presence of biofilm-forming bacteria, necrotic tissue and toxic products of the inflammatory process.4,5 Wound healing has stalled, disrupting progression to cellular proliferation and matrix repair.

Register now to continue reading

Thank you for visiting Wound Central and reading some of our peer-reviewed resources for wound care professionals. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Access to clinical or professional articles

  • New content and clinical updates each month