Effects of using a soft monofilament debriding mitt verse traditional gauze for wound bed preparation in painful lower extremity wounds

Problem:  Debridement of painful lower extremity wounds creates management problems for practitioners and suffering for patients.  Since pain and stress can delay wound healing, strategies for reducing procedural pain and anticipatory anxiety are important factors during the course of treatment.¹ Debridement and wound hygiene are a key concept in the T.I.M.E acronym for wound healing, but can be time consuming for the practitioner and create pain and anxiety for the patient.²

Previous practice:  Current procedures for wound bed preparation involves topical 2% lidocaine application for 10-15 minutes followed by either scrubbing with saline soaked gauze or sharp debridement with a curette. 

Proposed Solution:  Through the health system’s value analysis process, a soft monofilament debriding mitt (MDM) was approved for a clinical trial. A feedback form was developed to evaluate time to desired outcome, improved patient tolerance with debridement procedures, and an increase in effectiveness versus of our current protocol for wound bed preparation. Painful lower extremity wounds included; calciphylaxsis, vasculitis, venous stasis, and arterial wounds.  Clinical evaluation forms were completed by the CWON team and collected for analysis.

Results:  Our evaluation determined that the MDM was effective in removing devitalized tissue from the wound bed and surrounding skin, as well as keratosis from the lower leg. Patients were pleased with the soft feel of the mitt and tolerate the procedures better than with previous methods. Procedural times were decreased which supported a productivity gain that can be impactful for the value analysis process.  

Conclusion:  The evaluation of a MDM showed significant benefits over our current protocol for wound bed preparation in painful lower extremity wounds. As a result of this evaluation, the wound care team will support the adoption of a MDM for wound bed preparation and continue to implement this new technology into practice.