What is your preference for a wound that has fibrous debris in it that still needs autolytic debridement?
While Dr. Espensen says sharp debridement is the gold standard, he says enzymatic debridement agents such as Accuzyme and Gladase “work very well.” Dr. Karlock concurs, noting that he prefers Accuzyme for alert debridement but has also used Santyl and Gladase occasionally. Dr. Espensen adds that Panafil is a little less potent but also less painful. Dr. Jeffcoate opts for either an alginate (in possible combination with a hydrogel) or an iodine-containing preparation, whether it is a commercial iodine impregnated gauze or iodine cadexomer beads. Very occasionally, Dr. Jeffcoate says he will use a silver-sulfadiazine paste (Flamazine). According to Dr. Espensen, maggot therapy is also effective within a short period of time, and is a “very inexpensive” option compared to other debridement methods. Q: What products do you use on a highly exudative wound on the plantar foot? A: Dr. Jeffcoate usually employs an alginate or a foam dressing, whichever “preparation is sufficiently absorbent.”
