FACTOR 1: Infection - CONTROL INFECTION & ELIMINATE INFECTION PROSPECTIVE: Fresh wounds are seldom INFECTED – they are however invariably contaminated. They only become infected after 6-12 hours when bacterial infection becomes established. The threat of developing infection can be minimised / eliminated by flushing and irrigation with warm physiological solution under mild [controlled] pressure. Antiseptic solutions can be used if the wound is likely to be contaminated by pathogenic bacteria but otherwise should probably not be used. The natural antibacterial functions of inflammation are efficient and should not be harmed! Antibacterial dressings (Manuka honey) can be used to prevent infection from developing further in a wound that is not sterile. RETROSPECTIVE: Infection becomes established after 6 hours and can be a significant inhibitor of wound healing in chronic wounds. It is important to establish the bacteria involved by taking swabs from several sites in and on the wound– some infections are serious! As soon as swabs and if necessary tissue samples have been taken, the wound must be debrided and pressure flushed to get rid of as much infection (and biofilm) as possible. Use sharp surgical debridement to remove bulk infection and convert the wound to a clean (sterile) wound. Antibiotics may be required but generally are poor ways of controlling infection in a wound. FACTOR 2: Necrotic Tissue - REMOVE ALL LOOSE AND NECROTIC TISSUE PROSPECTIVE: Non-viable tissue in a wound bed is a strong inhibitor of healing and must be removed. Often, the tissue is visibly severely compromised and there is no point in leaving that in a wound site. Non-viable soft tissue does not bleed and so when tissue is removed that does not bleed a positive outcome is expected! As a rule viable tissue should be preserved. Surgical and /or hydro-surgical debridement should be performed to remove non-viable loose tissue fragments. The viability of tendon, ligament and bone can be hard to establish and often they only show “non-viability” after some weeks or even months. Burns cause skin and tissue necrosis that may be slow to become obvious. RETROSPECTIVE: Necrotic tissue of all types is often responsible for failed wound healing and persistent low grade inflammation in the wound bed. A full history of the wound will often establish whether this is likely factor in the failed healing process. Necrotic soft tissue is usually overcome relatively easily but bone, tendon and ligament are commonly involved because they are slow to manifest their lack of viability. Provided this is the only factor present, removal of the necrotic tissue will usually trigger a rapid healing process. Often necrotic tissue is complicated by infection and so this may have rot be considered also. Surgical debridement is usually required to remove necrotic tissue. www.kruuse.com
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