Debridement of Diabetic Wounds – How Is Wound EMR Helpful?

Diabetic wounds are often covered by scab, eschar or hyperkeratosis. Unless all necrotic, hyperkeratotic and devitalized tissue is removed, wound care specialists will find it quite difficult to properly assess or document the status of the wound. The presence of necrotic or foreign material may lead to the systemic release of cytokines, which promote a septic response. Wound care physicians can remove gangrenous, necrotic, ischemic and devitalized tissue using some method of debridement. If they fail to debride a wound when necessary, it could hinder delivery of proper treatment. However, it is difficult to determine which debridement method would be most suitable for your patient’s wound and this is where an EMR system designed specifically for wound care can help you.

What to Consider for Debriding a Diabetic Wound

  • Proper Wound Assessment – There should be a multisystem evaluation that includes the assessment of the patient’s neurologic, vascular and infection status. Each individual case should be considered very carefully. Wounds of patients having ischemic disease may not heal without some degree of vascular intervention. Physicians may spare the debridement in case of patients with terminal illness in order to avoid further discomfort. In case of wet necrotic tissue, immediate debridement is necessary.
  • Pros and Cons of Different Methods – Debridement methods widely used for diabetic wounds are:
    • Autolytic Debridement – This uses the body’s own enzymes and moisture to re-hydrate, soften and liquefy hard eschar and slough and is best for stage III or IV wounds with light to moderate exudates. Though this method is selective, easy to perform, mostly pain-free and safe, it may promote anaerobic growth while using occlusive hydrocolloid and the wound must be monitored thoroughly for signs of infection.
    • Enzymatic Debridement – This involves the use of fast acting chemical enzymes and is suitable for eschar formation and for any wound having large amount of necrotic debris. With proper application, there would be minimal or no damage to healthy tissue. However, it is expensive, requires a specific secondary dressing and may cause inflammation or discomfort.
    • Mechanical Debridement – This technique involving manual removal of dressing after allowing it to proceed from moist to wet, is best for wounds with moderate amounts of necrotic debris. Though the cost of the actual material is low, this method is non-selective, time-consuming and can be painful to patient.
  • Surgical Debridement – Sharp surgical debridement and laser debridement are best for wounds with large amount of necrotic tissue and those in conjunction with infected tissue. They are extremely fast, selective and effective while costly, painful and require transport of the patient at the same time.
  • Pain – Considering the patients’ pain is important for determining the type of debridement and level of anesthesia required. Most diabetic patients have peripheral neuropathy that may allow for subcutaneous level debridement without any additional anesthesia. However, certain diabetic patients do not demonstrate uniform loss of sensation or even an elevated level of sensitivity as a result of hyperesthesia.

Relevance of Wound EMR

Wound EMR is customized with built-in wound care templates to record necessary procedures such as debridement and application of synthetic skin. This will result in more comprehensive wound documentation so that wound care specialists can carefully examine and probe their patients’ diabetic wounds and make an effective decision on debridement. The major features of wound EMR include:

  • It integrates quantitative measures including healing rates and other relevant clinical data in real time. This provides an objective quantitative evaluation of the wound, with sequential measurements to determine the effectiveness of debridement. The automated alert system notifies physicians of a non-healing wound.
  • This system allows archiving of photos which encourage taking and saving pictures of wounds before and after the debridement from multiple angles and what has been removed from wounds at each visit, which will further expedite the healing process.
  • EMR system supported with an interface for physician and nurses will allow quick access to patient information and improve wound assessment.

Generation of customized reports will further speed up wound care procedures.