Lo sbrigliamento delle ulcere cutanee

The aim of this study is to review different methods of debridement in chronic wounds and to identify the evidence of debriding agents in wound healing. Debridement is an essential part of the tissue repair process and is defined as the removal of devitalized tissue from the wound bed. The accumulation of this tissue is regarded to prevent or delay granulation and epithelialization. Debridement techniques are divided into mechanical and non-mechanical methods on the basis of the physical peculiarities of the means employed and into selective and non-selective methods regarding the preservation or not of vital tissue from the wound bed. Advantages and disadvantages of each procedure are taken in to account to select the best form of debridement for each type of chronic wound. Surgical debridement is the most aggressive form and the more rapid compared to other techniques. It is essential to prevent infection and to remove dry thick eschars mainly in pressure ulcers. Autolytic debridement is the most easy and well tolerated from the patient and it is obtained through the use of occlusive dressings. Other forms of debridement such as the larva-therapy were used in the past and today have been reconsidered as useful and safe methods. The enzymatic and wet to dry debridements are the most common methods in our country and this is mainly due to the availability of these products. Chronic wounds are often contaminated with devitalized tissue and foreign material, which represent a barrier to cells migration and a source of infection. Selection of the debridement technique must consider the patient compliance, the wound size, the amount of exudate and the skill of the operator.