Wound hygiene and debridement in variable resource settings

Introduction: A novel minimally invasive wound hygiene and debridement technique utilizing Kylon fabric was utilized in the conflict zone setting of the occupied Palestinian Territory of Gaza. The aim of the study was to demonstrate the clinical utility of the device to support wound bed preparation in resource limitedMethods:Wounds were cleansed as able with available cleansing solutions in the environment then frictionally debrided utilizing the sterile, non-latex finger cot device (Soft K-Cot). This device has medical fabric coated with an array of stiff nylon hooks serving as curettes and brushes to clean and mechanically debride different tissue types within the complex wounds. These plastic hooks become micro curettes with pressure and were used to remove varying levels of tissue including slough, hypergranulation, biofilm, and fibrin. Patient response to treatment was noted and reported.Results:The frictional debridement finger cot device required minimal instruction on use to achieve desired wound hygiene and mechanical/frictional debridement in the complex wounds encountered. Surgeons, wound providers, wound specialist nurses, and clinic nurses reported ease of use and positive clinical efficacy. Patients tolerated the procedure with minimal pain. Disposal of the device was amenable to the low-resource setting as sharps containers were not routinely available. The single use, low cost, and small foot print of the device was also amenable to the conflict zone setting as reusable debridement supplies were not able to be routinely safely sanitized between patient use.Discussion: The common goal of care in conflict settings is to assist the victims of armed conflict and to preserve their dignity. Compassionate debridement with nylon medical fabric allows for low cost, clean, and expeditious wound bed preparation that is well tolerated. Standard peacetime health services are already limited or lacking in many low-income countries. With the addition of weapon wounded and those affected by adverse environmental conditions such as sanitation, housing, and poor nutrition, the hospital systems are quickly overwhelmed.   The lack of adequate resources includes diagnostic, therapeutic, and basic wound care supplies including soap, hand sanitizer, gloves, and gauze. Single use wound hygiene and debridement devices provide quick access to deliver care that is easily learned, clean, well tolerated, and effective.References:Giannou, C. & Baldan M. War Surgery. Working with limited resources in armed conflict and other situations of violence. Vol International Committee of the Red Cross. 2010. https://www.icrc.org/en/doc/assets/files/other/icrc-002-0973.pdf Leaper D. Sharp technique for wound debridement. World Wide Wounds. 2002. Available at: http://www.worldwidewounds.com/2002/december/Leaper/Sharp-Debridement.html. Accessed April 15, 2018. Urmila N, Nischal KC, Uday K. Techniques of Skin Biopsy and Practical Considerations. J Cutan Aesthet Surg. 2008 Jul-Dec; 1(2): 107–111. Winter M et al. Fabric-based exocervical and endocervical biopsy in comparison with punch biopsy and sharp curettage J Low Genit Tract Dis. 2012 Apr;16(2):80-7. Diedrich JT, Rathore S, Bentz JS. Comparison of Tissue Yield Using Frictional Fabric Brush Versus Sharp Curettage For Endocervical Curettage. JLow Genit Tract Dis. 2017 Oct;21(4):304-306. Sitelman A, Diedrich J, Lonky NM. Observation of a Robust Immune Inflammatory Response Following Frictional Fabric Cervical Biopsy and Endocervical Curettage During Colposcopy. J repro Med, 2019, 64(4), 261-4. 4. Bowler PG, Duerden BI, Armstrong DG. Wound microbiology and associated approaches to wound management. Clin Microbio Rev, April 2001, p. 244-269. RE, MAY 2013, p 211-219. Attinger C, Wolcott R. Clinically addressing biofilm in chronic wounds. ADVANCES IN WOUND CARE, VOLUME 1, NUMBER 3 , 2012, p 127-132