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Assessment and Management of Venous Leg Ulcers
Debridement is necessary to remove devitalized tissue and exudate, reduce the risk of infection,
prepare the wound bed and promote healing. Debridement can be:
Autolytic, the natural self-clearance of debris in the wound bed by phagocytosis and
proteolytic enzymes
Mechanical, the use of wet-to-dry dressings, hydrotherapy or irrigation with saline solution
Enzymatic
Sharp, using a scalpel or scissors (Fowler, 1992)
Select the method of debridement most appropriate to the client’s condition and goals.
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Sharp debridement is a high-risk procedure. Debridement with a scalpel should be undertaken
with caution and performed by specially trained and experienced healthcare professionals.
Subcutaneous debridement with a scalpel is a controlled act that must be carried out by a
physician or the delegate.
Discussion of Evidence:
There is no evidence to favour any one method of debridement, whether mechanical, autolytic,
enzymatic/chemical or sharp (NZGG, 1999). Fowler (1992) states that debridement of non-viable
tissue in open wounds is clearly an overlapping function of medicine and nursing, and nurses
who are trained to perform this function are practicing within the scope of nursing.
There is a body of research showing a wide variation in the clinical management of venous
leg ulcers through the use of dressings, however it is unlikely that a single type of dressing will
be appropriate for all types of wounds (Bryant, 2001). Bryant (2001)also explains that if the
dressing material transmits less moisture than the wound loses, then the wound will remain
moist. Several articles confirm that there are numerous types of wound dressings, bandages,
and stockings used in the treatment and prevention of recurrence (Lees & Lambert, 1992; Stevens,
Franks & Harrington, 1997). The RNAO guideline development panel, however, found insufficient
evidence to determine whether any particular dressing increases healing or reduces the pain
of venous leg ulcers. The most important factor, according to the Royal College of Nursing
(1998), is that the dressings be simple, low adherent, acceptable to the client, and low in cost.
The New Zealand Guidelines Group (1999) cautions that a number of cleansing agents
currently on the market may commonly cause skin sensitivity, and that some antiseptic and