Ask The Board: Debridement

The April 2010 print issue of Today’s Wound Clinic features a special product roundup section on Debridement products. In a preview to this issue we asked four TWC Editorial Board members for a snap shot of their Debridement practices.

What is your name? Val Sullivan
What is your position in the clinic? Clinical Manager
What wound care clinic do you work in? The Center for Advanced Wound Treatment Services: Capital Regional Medical Center in Tallahassee, FL.
What percentage of your patients would you say need debridement while treating them? 90%
What are some debridement products or services have you used or tried in your wound care clinic? Autolytic via moist wound healing, Mechanical via dressings, Pulsed Lavage with Suction, and sharps debridement as well as low frequency ultrasound.
Are there any products or services for debridement that you would strongly recommend to other clinicians? I would recommend having a large "tool box"... that is multiple options to choose from. Not all ulcers respond the same way to the same types of debridement. Multiple instruments should be available and in different sizes for sharps debridement. Pulsed lavage with suction is not only effective to assist debridement but offers wound bed cleansing and light negative pressure. For patient's that don't tolerate or require a more mechanical debridement, enzymatic agents, and biotherapy (Larval debridement or maggot debridement therapy) are wonderful tools to have.

What is your name? Desmond Bell, DPM, CWS, FACCWS
What wound care clinic do you work in? The Limb Salvage Institute and Wound Care On Wheels, LLC (we changed our name officially...no longer First Coast Diabetic Foot and Wound Management Center).
What is your position in the clinic? CEO
What percentage of your patients would you say need debridement while treating them? 95%
What are some debridement products or services have you used or tried in your wound care clinic? Over the years, Santyl, Accuzyme, Panafil, Kovia, Iodosorb. Surgically, we use scalpel blades and curettes. In the OR, Versajet has proven to be exceptional. I also utilize pulsed lavage in the OR and sometimes order this for my patients in an LTAC setting. I have not tried maggot therapy to date. I have not had the opportunity to personally use the MIST product or the Arobella acoustic systems in my practice. Both have also shown proven results in the wound care community.
Are there any products or services for debridement that you would strongly recommend to other clinicians? Santyl always has a place and is a tried and true product. Lodosorb is excellent for addressing bioburden and assisting in wound “clean up”. Every OR should have a Versajet available for surgical debridements. It is truly a difference maker.

What is your name? Charleen Ise, MD and Chris Morrison, MD
What wound care clinic do you work in? Bayfront Wound Care and Hyperbaric Center
What is your position in the clinic? Associate Medical Director and Medical Director
What percentage of your patients would you say need debridement while treating them? 80 - 90% require some type of debridement
What are some debridement products or services have you used or tried in your wound care clinic? Bensal HP, Santyl, in the past accuzyme and panafil, rarely chlorpactin wet to dry, GCP solution wet to dry and autolytic modalities
Are there any products or services for debridement that you would strongly recommend to other clinicians? Scalpel/excisional works best but I do like bensal HP and santyl of late.

What is your name? Andrew J. Applewhite, MD, CWS
What wound care clinic do you work in? Comprehensive Wound Care Center at Baylor University Medical Center, in Dallas, TX.
What is your position in the clinic? Medical Director
What percentage of your patients would you say need debridement while treating them? At least 80% of the patients need debridement at some time during their treatment.
What are some debridement products or services have you used or tried in your wound care clinic? Scalpel, Currette, Santyl, Ultrasound, Wet to Dry, Pulse lavage, etc.
Are there any products or services for debridement that you would strongly recommend to other clinicians ? This question is dependent on too many variables, but I prefer the scalpel.