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Tuesday, July 30, 2013

Chronic Ulcers may Heal Rapidly with Frequent Debridement

Posted by Dr Prahallad Panda on 8:41 PM Comments

Chronic ulcers are challenging to the health care providers. Most of the time it refuses to heal. Common among those are diabetic foot ulcer and pressure ulcer. Mostly, such ulcers are managed by frequent debridements, lavage and dressing.
Recent data from a study published in JAMA and quoted in Reuters supports the view.
Debridement involves removing the dead necrotic tissue from wound base and margins. Lavage is performed by hydrogen peroxide and washing either with normal saline or Ringer's lactate solution. This lavage removes a lot of bacteria load and necrotic tissue from the wound.
Platelets accumulate during the process of debridement to stop the small amount of bleeding that may occur, thereby adding the platelet-derived growth factor (PDGF) to the wound. This PDGF has a role in hastening the ulcer healing process. Also comes to the wound is the transforming growth factor that helps in wound healing.
Once circulating monocytes become tissue macrophages, they supply the key multiple growth factors for healing. A long-term wound gets trapped usually in the inflammatory stage, but aggressive debridement transforms it to an acute wound and therefore progresses to complete healing.
Debridement can be autolytic, enzymatic, mechanical, surgical, and biosurgical. Surgical, and enzymatic debridements are most preferred; to some extent autolytic also, when an occlusive dressing is applied for at least 24 hours.
Now, a Negative-pressure wound therapy (NPWT) is being talked about for speedy healing. In addition to debridement, rest to the part in the form of Total Contact Cast (TCC) is also found to be helpful in healing of diabetic foot ulcers.

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