Teaching Strategies for Conservative Sharp Wound Debridement (CSWD) using Video Demonstration

CSWD is defined as removal of loose, devascularized tissue, callous or hyperkeratotic tissue with the aid of a scalpel, scissors, or curette above the level of viable tissue.¹

It is important to train practitioners to be competent in CSWD as there is a growing body of evidence that effective debridement is associated with reduction in wound exudate, odour and the appearance of granulation tissue in the wound bed.²

An analysis by Coutts et al 2012, concluded that surgical and CSWD were the most cost effective debridement methods.³ Research also supports utilizing CSWD as part of the overall treatment of diabetic foot ulcers.⁴ However, these techniques are under-utilized as they are outside of the comfort zone of many practitioners. As a result, other techniques are often employed which may be more costly and less effective. It is imperative to create workshops that incorporate strategies to teach the technique of CSWD; including the hands on skill and safety techniques using a scalpel, scissors, and curette.

The standard content for the CSWD workshop was presented including definitions of non-viable/devitalized tissue, anatomy of the skin and structures encountered during debridement, benefits and contraindications, all methods of debridement as well as professional and legal issues including consent.  Further innovative teaching strategies included detailed videos of patients receiving CSWD by trained Wound Ostomy Continence (WOC) clinicians.  The videos incorporated a variety of different wound etiologies, and debridement tools.  The learner had the opportunity to view the practitioner’s technique, as well as recognize the benefits of CSWD through the use of before and after pictures. Additional videos included the demonstration of CSWD techniques on pigs feet. Participants practiced these techniques under the supervision of an experienced clinician. Workshop participants responded favorably with a renewed understanding of CSWD as a result of the “real life” videos.