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What is Chemical Debridement of Bed Sores?
By Nursing Home Law Center
Chemical debridement of a bedsore is when enzymes are applied to the wound to clear away dead tissue and promote the formation of healthy tissue in the healing process.What Are Bedsores?
Bedsores are wounds that develop gradually in persons who have been immobile for long periods. They are also called pressures sores and decubitus ulcers.
Normal, healthy individuals are constantly moving. Even when they sleep, they toss, turn and roll over which moves the weight-bearing parts of the body around so that no one spot is always bearing the brunt of the pressure.
In patients who are comatose, paralyzed or too weak to move, the same parts of the body tend to always come under pressure. Caregivers should turn them frequently to avoid these problems but not all caregivers are diligent enough in their duties.How Do Bedsores Form?
Generally, pressure applied continuously to a body part will cut off the blood flow and lead to a pressure sore forming. Patients who lie in bed with little or no movement are at high risk of developing a bedsore, and indeed bedsores are frequently seen in nursing home patients and other immobile individuals. There are three situations that cause most bedsores.
- Pressure. A patient confined to a wheelchair, for instance, may apply pressure continuously to the same areas of the body. A patient lying comatose in bed is at the same risk. The skin and tissue, cut off from blood flow, begin to die.
- Traction. Another kind of pressure that can cause a bedsore. A patient propped up in bed experiences traction between the force of gravity pulling down on his or her body and the surface of the bed resisting the gravity. Staying too long even in a propped-up position can lead to the formation of a bedsore.
- Friction. Constant friction of a surface against the same part of a body can also form a pressure sore, wearing away at the skin and creating a wound underneath.
Treatment options vary, and the severity of the bedsore will go a long way to determining which one is appropriate in a given case. Treatment options include:
- Debridement. This is the removal of dead tissue so that healthy tissue can grow back.
- Wound Vacs. A wound vac drains a bedsore and fills the crater with a foam-like substance to promote healing and prevent infection.
- Flap Reconstruction Surgery. For severe cases of bedsores, a doctor may perform a surgery to cover the wound. He or she chooses healthy skin from elsewhere on the body and closes the wound with it.
- Amputation. In the worst cases, in order to save a patient's life and the rest of his or her limb, it may be necessary to amputate. Removing the unsalvageable part of the limb allows the rest of the body to heal.
Debridement is very common for bedsores, especially if they have progressed into open wounds. There are several different ways of debriding a wound.
- Chemical Debridement. Enzymes are applied to the wound. These enzymes will get rid of the dead tissue and promote the growth of healthier tissues.
- Autolytic Debridement. This involves applying a moist dressing to the wound to prevent infection. The body's own enzymes can then go to work on the dead tissue. Autolytic debridement requires a body healthy enough to do its own healing. For advanced cases of bedsores, it may be inadequate.
- Surgical Debridement. A surgeon cuts away the dead tissue from a wound. This surgery usually involves flap reconstruction.
- Biological Debridement. An ancient cure recently approved for modern medicine, biologic debridement is the placing of maggots in the wound. This is an effective and gentle way to debride a wound, with the maggots eating the dead tissue but leaving the living tissue alone. The maggots also excrete chemicals that protect against infection and promote healing in the wound.
- Mechanical Debridement. A less gentle way of debriding, mechanical debridement applies a damp dressing to a wound, waits for it to dry, and then rips it off. This tears away the dead tissue. It can also tear away still living tissue and can be painful.