First of all, in order to assess the wound correctly, we must be able to see the tissue structure of the wound bed clearly. Dead or inactivated tissue not only hinders the wound healing process, but also increases the risk of infection and sepsis. Dead tissue or foreign matter is a good culture medium for bacteria. The goal of debridement is to "recover" the acute state of the wound, thereby restarting and accelerating the normal healing process of the wound.
Second, biofilms are found in 60% to 90% of chronic wounds. Mature biofilms have physical and metabolic defense mechanisms. These defense mechanisms allow biofilms to resist host immunity, antibacterial agents, bactericides, antibiotics, and ultraviolet rays. Sequential device debridement can destroy the growth and inhibitory factors of the biofilm, thereby promoting wound healing.
Management of granulation overgrowth and curling
Silver nitrate rods are considered an antibacterial agent and are used to enhance anti-inflammatory healing. The silver nitrate rod uses a chemical etchant composed of 75% silver nitrate and 25% potassium nitrate. When the wound fluid soaks its head, a chemical reaction occurs: killing bacteria, removing necrotic tissue, reducing overgrowth of granulation tissue, inhibiting fibroblast multiplication, and coagulating tissue.
Granulation hyperplasia is the excessive growth of granulation tissue that exceeds the normal wound bed level. Appears to be red, fragile, moist and shiny. Rotating the tip of the silver nitrate rod on the surface of the wound tissue can reduce the hyperproliferation of granulation tissue. This method can make the wound acute and restart the healing process.
Epibole is a common problem with full-thickness wounds. In the healing of an open wound, granulation tissue will grow from the base of the wound upward to fill the tissue defect, while epithelial cells migrate from the periphery to the center to cover the entire wound surface. When epidermal cells grow to the sides instead of passing through the wound, the edges of the wound curl or roll down. Wound curling can be dealt with by the following methods: silver nitrate rod; instrument debridement; mechanical debridement (rubbing the wound edge with gauze).
