Introduction

Patient-centered care is a philosophy that stresses communication, collaboration, and health promotion while also respecting patients' expectations, autonomy, and values. It is at the heart of global efforts to enhance the delivery of safe, high-quality, and cost-effective health care. Patients who are involved in their own treatment are more motivated and capable of caring for their own health and well-being, according to most research, because they understand the impact the treatment will have on their health.

Patient empowerment is especially effective when patients are involved in decision making about debridement treatment methods. Debridement treatments should be considered for efficacy as well as the patient’s comfort level with the treatment. Informing patients of the debridement process and its importance, as well as reviewing pain management options, is essential not only for outcomes, but also for the patient’s quality of life.

Debridement Considerations: BEAMS

There are five primary methods of debridement that can be used alone or in combination as appropriate. BEAMS is a mnemonic that is commonly used to remember these methods.

Biological Debridement

Biological debridement is the use of sterile maggots of Lucilia sericata (green bottle fly), which consume dead tissue and pathogens. This treatment consists of applying sterile maggots to the wound bed and covering them with a dressing. Creating your own custom or preassembled dressing is an option.¹

Enzymatic Debridement

Enzymatic debridement is carried out by applying a topical agent that liquefies necrotic tissues with enzymes. The enzymatic action of the agent dissolves and engulfs devitalized tissue in the wound. One approach, collagenase debridement, works well in combination with surgical and sharp debridement. This method can be costly depending on the payer source, although there are discount programs available. Enzymatic debridement is less painful than some other methods and can be administered every day by nurses.²

Autolytic Debridement

Autolytic debridement is an approach that utilizes the body's own enzymes and moisture to liquefy nonviable tissue beneath a dressing. With this method, it is critical to maintain a proper moisture balance. The frequency of dressings and absorbency should also be considered. The most frequently used dressings for this method are hydrocolloids, hydrogels, and transparent films (semiocclusive and occlusive).²

Mechanical Debridement

Mechanical debridement is accomplished through irrigation, hydrotherapy, wet-to-dry dressings, and an abraded technique. This technique is inexpensive, but it can harm healthy tissue and is usually painful.²

Surgical Sharp and Conservative Debridement

Surgical sharp and conservative debridement is performed by a skilled practitioner using various surgical instruments such as a scalpel, curette, scissors, rongeur, or forceps to perform the procedure. By removing biofilm and devitalized tissue, this type of debridement promotes wound healing. The most aggressive type of debridement is surgical debridement, which is performed in a surgical operating room. Sharp and conservative debridement with sterile instruments can be performed in a clinic or at the patient's bedside.²

Discussing the Care Plan With Your Patients

Patients are rarely involved in the assessment, management, or prevention of their own wounds because these tasks have traditionally been viewed as the responsibility of a health care professional. Patients' involvement in their health care, on the other hand, increases their experience and happiness while also having clinical and economic benefits. Most studies show that patients who participate in their own treatment are more motivated and capable of caring for their own health and well-being because they have a better understanding of health and illness.

The details of their wound care appointment, such as debridement methods, pain management options, and the significance of the appropriate treatment for their wound, should all be discussed with the patient. Both clinicians and patients must be educated to understand where patient involvement fits into the treatment process and how it is based on the notion of choice. The impact of patient involvement on the individual's knowledge, abilities, and attitudes, as well as their judgments of their level of involvement, should be considered in the evaluation.^3,4

Discussing Alternative Debridement Options With Your Patients

Patients with painful wounds frequently experience anxiety and apprehension. Often, patients may believe that all such debridement methods must be terrible, and these patients are distrustful of future wound treatments and wound care providers. Patients who are in pain, anxious, or depressed may skip numerous appointments. Social and cultural variables have a role in patients and caregivers opting out of sharp debridement.⁵

Utilizing less aggressive debridement methods such as autolytic and enzymatic debridement can be a better option for some patients who have painful wounds and anxiety. Enzymatic debridement is a painless, topically applied method of wound debridement that utilizes naturally occurring proteolytic enzymes for the purpose of removing devitalized tissue. Autolytic debridement is the process of removing necrotic debris and devitalized tissues from a wound by creating a moist environment conducive to the activity of the body's own endogenous enzymes.²

Pain Management Options

Before providing any medication to people with chronic pain, a baseline level of pain and function must be established. Pain that has lasted at least three months is classified as chronic pain. To manage mild to moderate pain effectively, a range of treatments can be used in combination.

Alternatively, acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), topical anaesthetics such as lidocaine patches, salicylate creams, transcutaneous electrical nerve stimulation (TENS), and others should be enough to handle varying levels of pain as needed. Prescription opioids, such as extended-release or immediate-release oxycodone, are frequently prescribed for severe pain. To reduce the risk of dependence and/or overdose, opioids should be administered at the lowest effective dose. To ensure the best monitoring, pain management may be recommended.⁶

Conclusion

If clinicians educate and explain to patients how wounds heal, how to cleanse and dress their wound, and what options are available, this information can make a major difference in how well these wounds heal. When patients have a say in their care and are able to ask questions, they become more involved and better learners. When selecting debridement methods, it is especially important that patients are aware of each option’s particulars. There are five different types of debridement methods, but many factors influence which one is best for your patient. When determining which method of debridement to use, clinicians should consider not only the wound assessment but also the patient's history and physical examination.

References

1. Sherman RA. A new dressing design for use with maggot therapy. Plast Reconstr Surg. 1997;100(2):451-456.
2. Leaper D. Sharp technique for wound debridement. World Wide Wounds. 2002. Accessed March 16, 2022. http://www.worldwidewounds.com/2002/december/Leaper/Sharp-Debridement.h…
3. Vahdat S, Hamzehgardeshi L, Hessam S, Hamzehgardeshi Z. Patient involvement in health care decision making: a review. Iran Red Crescent Med J. 2014;16(1):e12454. doi:10.5812/ircmj.12454
4. Moore Z, Bell T, Carville K, et al. International best practice statement: optimising patient involvement in wound management. Wounds International. 2016.
5. Addressing the pain: pain doesn’t have to be a part of wound care. Wound Manag Prev. 2003;March. Accessed March 25, 2022. https://www.hmpgloballearningnetwork.com/site/wmp/content/pain-doesnt-h…
6. Suzuki K, Lockhart BS, Birnbaum Z. Principles in pain management for wound care patients. Podiatry Today. 2018;August. Accessed March 25, 2022. https://www.hmpgloballearningnetwork.com/site/podiatry/principles-pain-…