DEBRIDEMENT – CRUCIAL PROCEDURE IN THE TREATMENT OF CHRONIC WOUNDS

Abstract

Debridement je proces uklanjanja mrtvog tkiva iz rane. Devitalizirano tkivo usporava ili u potpunosti onemogućava zarastanje rane. Cilj debridmana je pretvaranje kronične rane u stanje akutne rane i iniciranje procesa zaraštavanja. Debridement je osnovni postupak u liječenju svake rane, ali i tretman koji se mora ponavljati u zavisnosti o stvaranju nekrotičnog tkiva. Postoji više načina debridmana. To su mehanički, autolitički, kemijski, enzimski, biološki i novi načini debridmana. Napredovanjem tehnologije uvode se i novi oblici debridmana. Tako se osim standardnih metoda sve više uvode i metode debridiranja vodenim mlazom pod pritiskom (hidrokirurgija, water-jet), te ultrazvučno asistirani tretman rana (uAW). Metoda debridmana za koji se liječnik odlučuje ovisi o količini devitaliziranog tkiva prisutnog u rani, veličini i dubini rane, osnovnoj bolesti, te eventualnom komorbiditetu i ukupnom zdravstvenom stanju. često se metode debridmana međusobno kombiniraju kako bi se postiglo što bolje uklanjanje devitaliziranog tkiva. Debridement osim toga i signifikantno smanjuje broj bakterija u rani.Debridement is the process of removing dead tissue from the wound bed. Devitalized tissue can obstruct or completely stop healing of the wound. The aim of debridement is to transform a chronic wound into an acute wound and to initiate the process of healing. Debridement is the basis of each wound treatment and it has to be repeated, depending on the necrotic tissue formation. There are several types of debridement, as follows: mechanical, autolytic, chemical, enzymatic, biological, and new debridement techniques. With advances in technology, new types of debridement have been introduced. Besides standard methods, methods of pulsed lavage debridement (hydro-surgery, water-jet) and ultrasound-assisted wound treatment are ever more frequently introduced. The method of debridement the clinician will choose depends on the amount of necrotic (devitalized) tissue in the wound bed, size and depth of the wound, underlying disease, possible comorbidity, and the patient general condition. Frequently, the methods of debridement are combined in order to achieve better removal of devitalized tissue. In addition, debridement significantly reduces bacterial burden