Wound Mapping: A Guide to Targeted Debridement and Wound Healing

Presented by: Dr. Stephan Landis, Consulting Internist Wound Physician - Department of Hospital Medicine, Ambulatory Wound Clinic Guelph General Hospital CCAC
Sponsored by: MolecuLight
Produced by: Ontario Hospital Association
Partner: Canadian Association of Wound Care
Date: February 24th 2016
 
 
Much has been written about the debridement of chronic wounds, an essential element of the D-I-M-E (Debridement, Infection or Inflammation, Moisture balance and Edge of wound) mnemonic of the wound bed preparation (WBP) paradigm.
 

Debridement has been established to:

  1. remove devitalized tissue, which attracts active bacterial growth
  2. remove wound bed biofilm, which may be active in microbial persistence
  3. remove local infected tissue, which contains active replicating bacteria
Several methods have been advocated for debridement, including autolytic, enzymatic, mechanical and sharp surgical.
 
 
“Mapping the wound” is a new technique based on microbial autofluorescence imaging of the wound that locates patterns of microbial growth. This mapping gives important visual and objective pre- and post-debridement information about the wound at the bedside in real time.
A recent Canadian prospective pilot study using pre- and post-debridement autofluorescence studies of 60 wounds in 28 clinic patients, with a range of underlying diagnoses, revealed that even in expert hands, sharp surgical debridement failed to remove 60% of bacterial groups in wounds.
The importance of reducing microbial load in the wound is recognized as an important step in wound healing and forms the “I” component of the wound bed preparation paradigm.
 
 
Stratification of clinic visits based on the comparative intensities of pre- and targeted post-debridement autofluorescence may better promote wound healing, when incorporated into a holistic patient management strategy.
 
 
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