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Debridement of Bed Sores
When a comatose patient is lying in bed for a long time, or when illness or injury confines someone to a wheel chair, they are at risk of developing decubitus ulcers, more commonly known as bedsores or pressures sores.
The pressure on certain parts of the body cuts off the flow of blood and thus deprives the body part of oxygen. This causes the skin and underlying tissue to eventually die. A gaping wound can form and get infected.
The Stages of a Bedsore
Bedsores rank according to their severity. They fall into one of four categories.
- Stage I. At stage I the bedsore is incipient. It is detectable as a redness of the skin without breakage. It may feel warm to the touch or hard. Quite possibly it is swollen.
- Stage II. Stage II sees the first breakage of skin. Abrasions form, or possibly blisters. An infection risk begins to develop.
- Stage III. The skin has finally worn away and uncovered the underlying tissue, which itself is now damaged. A wound with a crater-like appearance has formed and the infection risk is greatly elevated.
- Stage IV. Stage IV is life-threatening. The tissue under the skin is now gone, too, exposing the muscle and bone underneath. Infection is almost a certainty.
Depending on the severity of the pressure sore, doctors recommend different treatments. Debridement is simply the removal of dead tissue. Debridement of some kind is a very common treatment for bedsores at stages III or IV, and sometimes earlier. There are several different ways to debride the necrotic tissue of a bedsore.
Autolytic debridement involves dressing the pressure sore with moist wrappings. The objective is to keep the wound clean while the body’s own enzymes heal the wound. Some consider this the easiest and most natural way to debride a wound, but it is not always feasible.
In later stages of a bedsore, there may be too much tissue for a body to heal. Also, a person who has reached that state is probably weak and their body may have lost some ability to heal itself.
Autolytic Debridement is easy and painless, but not always appropriate.
A mechanical debridement of a bedsore is akin to ripping a Band-Aid off one’s skin. It is painful and quick.
The physician packs the bedsore with damp dressings allows them to dry out. When they have dried and presumably attached themselves to tissue in the wound, the physician rips them out, bringing dead and sometimes living tissue with them.
This method can be very painful, although it does have the advantage of not requiring the body to be strong enough to heal itself.
Chemical debridement is the application of enzymes to a wound to dissolve and wash away the dead tissue. This can be advantageous if the body cannot heal itself. It takes longer than mechanical debridement but is less painful.
Biological debridement, under various other names, has been around since at least Classical Antiquity. It has recently resurrected for use in modern medicine.
It sounds low-tech but it yields impressive results: a doctor places living maggots in the wound and lets nature take its course.
This may sound incredible to some, but the technique shows a lot of promise. The maggots eat the dead flesh in the wound – but only the dead flesh. They also excrete a substance that not only prevents infection but aids in the body’s natural healing. Wounds treated with maggot therapy heal far faster than wounds without such treatment.
A surgeon cuts away the dead part of the wound and may use healthy skin from another area of the body to cover it over.
Better attention to detail could reduce the incidence of bedsores in all populations. However, if one does form there are ways to treat it. Debridement is one of the most common.