References
Ultrasonic-assisted wound debridement: report from a closed panel meeting
Abstract
Mechanical debridement can be considered as an alternative to surgical debridement if surgery is not available, or is considered impractical or too high risk. One form of selective mechanical debridement is ultrasonic-assisted wound (UAW) debridement. As the published evidence on this is limited, a closed international expert meeting was held to review the existing evidence base on it, present preliminary findings of research currently in progress and discuss individual cases selected from the clinical experts' own practice. The panel also explored the potential barriers to the implementation of UAW debridement and how these might be addressed. It concluded there is sufficient evidence that UAW debridement is an effective method of cleansing and debriding almost all hard-to-heal wounds. Patients who are most likely to benefit from it are not medically stable, on anticoagulants, unable to visit a hospital for wound treatment, and/or have wounds with a poor vascular supply or are close to critical structures. The panel also observed that UAW debridement can be used to prepare the wound for negative pressure wound therapy (NPWT) or as an adjunctive to it. Given the potential to experience pain during the procedure, the panel considered that patients will benefit from topical analgesia. The panel noted that health professionals, patients and visitors must be protected from the aerosolisation associated with UAW, to reduce risk of cross-contamination.
Sequential debridement has been the cornerstone of wound management for decades. This practice was reinforced in 2008 when awareness of the significance of biofilm in hard-to-heal wounds surfaced in the literature.1 Although surgical debridement is considered the gold standard, it is not always practical, available or suitable for each patient. Therefore, alternative debridement strategies, including sharp, mechanical, enzymatic, larval and autolytic, can be considered.2 Mechanical debridement comprises therapeutic irrigation, aggressive cleansing with moistened gauze, monofilament pads, scraping with a dull device and ultrasonic-assisted wound (UAW) debridement, also known as low-frequency contact ultrasonic debridement (LFCUD).
UAW debridement can be used to prepare the wound bed for dressings and/or grafting.3,4,5 Information on UAW debridement, including its indications for use, debridement properties and antimicrobial and antibiofilm effects, has been outlined by Braumann et al.6
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