A new approach to debridement of wounds in patients with diabetes
Paul Chadwick and Sam Haycocks
Aims/Objectives: To evaluation the impact of the Hydro- Responsive Wound Dressing (Hydroclean plus) for debridement and wound bed preparation in patients with diabetes.
Introduction: Diabetes is a burgeoning disease in the UK and worldwide, new figures, extracted from GP patient data, show that there are now 4.05 million people with the condition in the UK. Diabetes is associated with a number of risk factors of which diabetic foot ulceration (DFU) leading to amputation is a main one (McKinnes, 2012). As such diabetes and associated conditions put an enormous pressure on the NHS, the cost of diabetes care to the NHS was almost £10 billion in 2011 (10% of the total NHS budget) of which most of this spending was on managing avoidable complications, accounting for 80% of the total NHS diabetes cost (Hex et al., 2012). Managing a diabetic foot ulcer, healing it and preventing amputation if it deteriorates is a significant challenge to healthcare workers. In order to support clinicians treating this disease a recent document has been developed that focuses on wound management best practice for diabetic foot ulcers (Best Practice Guidelines, 2013). A cornerstone of treatment in this Best Practice document and other guidelines is wound bed preparation and the use of debridement to remove devitalised tissue that hinders healing and forms a nidus for the growth of bacteria and therefore infection .
A number of debridement methods are used which meet with varying levels of success and have different cost implications. However a new and unique debridement and cleansing treatment Hydroclean plus has been developed that enables the removal of the devitalised tissue by the bodies own “safe” mechanism of autolysis and thus enables subsequent initiation of re-epithelialisation and healing.
Methods: HydroClean plus was used to remove devitalised tissue from the diabetic foot ulcers included in this study. Hydroclean plus consists of a superabsorbent wound dressing pad which creates, in combination with Ringer’s solution, a moist environment when applied. The absorbent core of HydroClean plus is a superabsorbent polyacrylate (SAP) contained within a cellulose matrix. These polymers are able to absorb large amounts of fluid due to the material’s chemical properties (Buchholz and Graham, 1998). The material’s ability to donate moisture and absorb bacteria and proteins within the pad is facilitated by the presence of Ringer’s solution-activated SAP (Bruggisser, 2005; Eming et al, 2008). Bound bacteria and proteins are then removed from the wound when the dressing is changed. In addition, the antiseptic polyhexamethylene biguanide hydrochloride (PHMB) is bound to the SAP core. The wound contact layer of HydroClean plus is composed of a non-adherent hydrophobic layer which conforms well to the wound surface. The presence of pores within the wound contact layer allows free exchange of Ringer’s solution and wound exudate (Mwipatayi et al, 2005). This layer also contains silicone strips to prevent the dressing from adhering to the wound and aid atraumatic dressing.
This study was undertaken as a “collective case study series”, this involves studying multiple cases simultaneously or sequentially in an attempt to generate a broad appreciation of a particular issue (treatment regimen). This case study series was undertaken in an acute NHS Trust. Diabetic patients undergoing routine treatment for their wounds, but specifically in need of removal of devitalised tissue (eg slough/eschar) were entered into the evaluation. HydroClean plus was used to remove devitalised tissue and prepare the wound bed for the second phase, re-epithelialisation and healing.