Debridement and preparation of wounds

I haven't updated my article on VSD technology in a long time, and I recently went out for a walk and looked at it. I also learned about the VSD market and the use of hospitals. However, through many ways, we have learned that although VSD negative pressure drainage has been widely used in the clinic, there are still many friends who do not know what VSD is. I also hope that more friends can learn more about VSD technology, because the really good treatment effect must have a wealth of theoretical knowledge and clinical practice.

What I would like to talk to you about today is debridement before using VSD negative pressure drainage.

Debridement is an important step in the preparation of the wound and its subsequent healing. Debridement is defined as removal of necrotic or damaged tissue, or foreign body, from the wound surface. The first recorded debridement in history should be traced back to Guy de Chauliac in France in 1363, when he recognized the importance of removing necrotic tissue from wounds and its positive effects on wound healing. The removal of inactive tissue is now considered to be the single most important factor in the treatment of contaminated wounds. The first step in judging the wound is an assessment of necrotic tissue. In fact, the presence of inactivated tissue hinders the evaluation process, the observation of the wound, and creates physiological obstacles to wound healing. It is impossible for the wound to heal until the necrotic tissue has been removed, and clinical experience has shown that removing necrotic tissue, exudate, and metabolic waste from the wound can shorten the time to heal. Adequate blood circulation should be established before any debridement action is done.

Inactive substances are a source of infection and can support the growth of pathogenic bacteria in them, delaying wound healing. Reducing the bacterial load by debridement reduces the likelihood of infection and avoids making chronic trauma incurable due to a persistent inflammatory response. In addition, the cells and fluids of the chronic wound no longer respond to the signal of healing, and the fibroblasts of the chronic wound become weak and do not respond to growth factors. By debridement, we cleared these cells and restored the wound's response to healing signals.

If the inactive substance dries out and turns black or brown in color, a eschar is formed. Eschars are usually tougher and harder, manifesting as a dry epidermis and a lack of blood flow to the dermis and subcutaneous tissues. This necrotic tissue is an important obstacle to granulation and wound healing. However, the eschar does not form overnight, and care should be taken to change the color within the wound, usually yellow, then gray, and finally black. Yellow and gray tissue generally suggests shedding tissue (slough) or necrotic protein substances such as collagen, fibrin, and elastin. Sometimes a yellow color appears after the black tissue is removed, which indicates that the wound is progressing slowly, such as a venous calf ulcer. Stubborn yellow tissue is the result of a mixture of vascular-free fat, collagen, fibrin, and exudates containing white blood cells. The healthy color of the wound during healing is red, and the red wound like beef generally indicates a healthy granulation base and has an appropriate supply of arterial vessels.

In most cases, removal of inactivated tissue during wound treatment is the first step of caution. The choice of debridement method is based on the patient's condition, timing, tissue characteristics, pain, exudation, infection, cost, and overall goals. When immediate drainage or removal of inactive tissue is clinically unnecessary, mechanical, enzymatic, or autolyzymatic debridement techniques may be selected. Usually, we must first consider the patient's overall situation holistically, and if immediate debridement is required, such as progressive cellulitis, abscesses, or sepsis, sharp debridement or surgical debridement should be performed immediately.

Therefore, debridement before the use of VSD is very important, and the treatment effect of different debridement effects will be different in the end.