How do you know if your debridement intervention is working? NIRS imaging provides enhanced clinical evidence.
Debridement, a crucial intervention for chronic wounds, involves the removal of necrotic and nonviable tissue.
The removal of fibrin and necrotic debris and stimulation of the hemostatic phase is essential to aid the healing process of chronic wounds such as diabetic foot ulcers, venous leg ulcers, and pressure injuries (1). Debridement can help improve the healing environment of a wound by (1):
removing a barrier to granulation tissue formation that is needed for wound closure.
promoting angiogenesis and vasculo-genesis.
allowing clinicians to accurately gauge the size of the wound and monitor size reduction.
facilitating wound bleeding and exudate, allowing the clinician to collect a culture sample if required.
Figures 1 and 2 show a patient pre-debridement with an average StO2 of 57%, demonstrating an average StO2 increase of 10% post-debridement.
While no specific type of debridement is universally recommended over another, a combination of treatments is often utilized to optimize therapeutic outcomes for patients suffering from chronic wounds (1-3). This table summarizes the types of debridement procedures commonly used (1).
Types of debridement
Without a clear consensus on what technique to use on which wound, clinicians are required to use their clinical judgement based on available expertise, patient preference, and cost to determine a treatment direction (2). To aid clinicians in their decision-making process, NIRS imaging provides critical data at the point-of-care which can be used pre- and post-debridement to confirm intervention efficacy.
SnapshotNIR is a handheld device that uses reflectance-based technology to measure relative amounts of oxygenated and deoxygenated hemoglobin at the superficial level, 2-3mm below the surface of the wound, capturing an accurate measure of microcirculation which is indicative of wound healing.
case example using snapshot
As seen in Figure 3 and 4, the images from SnapshotNIR, including hemoglobin view, can show tissue oxygen saturation changes within the wound bed and the peri-wound, providing additional evidence of the clinician’s treatment plan. Hemoglobin view in this case shows the typical trend of deoxyhemoglobin decreasing and oxyhemoglobin increasing from pre- to post-debridement. As well, a change in average StO2 was seen in the wound of an increase of 16%.
The user-friendly interface allows the clinician to view the color image next to the oxygenation map, as well as, comparing before and after images.
As seen in Figures 5 and 6, comparisons between intra-wound and peri wound StO2 can indicate a successful debridement procedure. Using Snapshot to guide debridement to remove ischemic tissue in the wound bed and peri-wound can improve wound closure rates and decrease the use of unhelpful interventions.
Read more about using NIRS in conjunction with debridement for successful patient outcomes in this case study by Dr. Doug Toole.
Start using hemoglobin view in your practice, read more about it in this blog post.
References:
1. David Dayya, Owen J. O'Neill, Tania B. Huedo-Medina, Nusrat Habib, Joanna Moore, and Kartik Iyer. Debridement of Diabetic Foot Ulcers. Advances in Wound Care. Dec 2022.666-686. http://doi.org/10.1089/wound.2021.0016
2. Elraiyah T, Domecq JP, Prutsky G, Tsapas A, Nabhan M, Frykberg RG, Hasan R, Firwana B, Prokop LJ, Murad MH. A systematic review and meta-analysis of debridement methods for chronic diabetic foot ulcers. Journal of vascular surgery. 2016 Feb 1;63(2):37S-45S.
3. Liu WL, Jiang YL, Wang YQ, Li YX, Liu YX. Combined debridement in chronic wounds: A literature review. Chinese Nursing Research. 2017 Mar 1;4(1):5-8.
4. Niezgoda J. Wound Debridement. In: Krasner DL, Rodeheaver GT, eds. Chronic Wound Care: The Essentials A Clinical Source Book for Healthcare Professionals. 5th Edition. Malvern PA, HMP Communications (2014).