Apart from surgical debridement are there other ways of debriding an ulcer

The enzymatic and chemical debridement methods are available. In the first case, autolytic, proteolytic enzymes (papain, collagenase and streptokinase) are applied on the ulcer surface daily. This type the debridement is recommended when there is extensive necrosis or when surgical debridement is not possible due to pain. Disadvantages of enzymatic debridement are its high cost and the irritation it can cause when applied on healthy skin. Use of sterile maggots (larvae) is included in the enzymatic debridement as well. Maggotts are the larvae of the green fly (gender Lucilia sericata). The larvae are received and developed in a special sterile environment. When they are applied on ulcers with necroses or infection, they have the attribute to 'only eat' the abnormal tissue while leaving the healthy tissue intact, thus cleansing the surface of the ulceration. This treatment is painless, safe, relatively cheap and effective.

Chemical debridement is performed by applying hydrogels (Table 17.7). Hydrogels help in the cleansing of the ulcer surface when this cannot be performed surgically. They are, however, inferior to the surgical debridement, because, on the one hand, onset of their action is delayed and on the other hand, their effectiveness is lower.

Table 17.7. Characteristics and indications of various dressings Advantages Disadvantages

Gauze impregnated with NaCl solution

Membranes

Foamy dressings Hydrogels

Hydrocolloids Alginate

Cheap and available everywhere Suitable for ulcers with dry gangrene as well Hemi-transparent, low cost, form a barrier for the microbes, should be changed every 4-5 days Suitable for ulcers with abundant exudate, easily applied Effective, easily applied, not irritant for the healty skin, decrease the risk of infection, remove exudates, suitable for ulcers with crpts

It is attached on the surface of the ulcer and may cause bleeding at removal Suitable only for superficial ulcers

Absorbance ability of the various foamy dressings varies Surgical debridement is superior, unsuitable for ischaemic/ neuroischaemic ulcers, frequent inspection of ulcer is required for timely diagnosis of possible infection They predispose to superinfections, especially from anaerobes

Unsuitable for neuroischaemic ulcers with small exudate. They predispose to superinfections. They dryout the ulcer surface and may cause bleeding at removal

Suitable for necrotic ulcers with moderate quantity of exudates. They do not require daily removal Very useful when there is abundant exudate, suitable for superinfected ulcers as well, some also have haemostatic properties

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