Mile 2: Jetox - a solution for patients who cannot tolerate sharp debridement
December 8, 2014
Have you treated or cared for a patient who could not tolerate sharp debridement due to pain intolerance? Or, have you found that the next step for a patient was to take them to the operating room to remove the devitalized tissues present on their wound bed? After almost a decade of being involved with wound care treatments, I know that this situation is very prevalent.
“With the introduction of Jetox into our clinic, we are now able to debride 5 patients on a weekly basis whom previously did not tolerate sharp debridement. What a godsend! I can tell you that patients are grateful for having found a modality which allows appropriate debridement with much reduced (or no) pain.” Harvey Hashimoto MD, Medical Director, Lodi Health Wound Treatment Center, Lodi, CA
As many know, debridement is an appropriate treatment to transition a chronic wound to resemble an acute wound by improving the protease and cytokine levels. If a wound has necrotic tissues present, it is not considered a healthy wound bed, which can increase healing times for the patient. With sharp or surgical debridement being the quickest and most effective option for debridement, many patients have pain at their wound bed and cannot tolerate this option of debridement. As a clinician, we want these wounds to have the best chance at healing as quickly as possible. The less time it takes to heal, the less chance the wound has to get infected or cause further issues for the patient. Other options for debridement include autolytic, mechanical, enzymatic/chemical, and bio-surgical. I have listed some of the features of each type of debridement along with potential downfalls from each of these:
- Autolytic debridement is the destruction of necrotic tissues that use the body’s white blood cells and natural enzymes to digest the devitalized tissues while leaving healthy tissues intact. This can be a very slow process, as some patients do not have a sufficient amount of white blood cells to complete this process. While this is the least invasive method of debridement, it can also be the slowest.
- Mechanical debridement is a non-selective form of debridement. Force is used to manually remove a dressing with hopes that the necrotic, or non-viable, tissues are removed along with the dressing. This form of debridement can be very painful and, since it is non-selective, the chance of removing healthy tissues along with the non-viable tissues is high.
- Enzymatic/Chemical debridement products dissolve necrotic tissues. Currently, there are only 1-2 products in the wound care market that meet standards for enzymatic debridement. From my experience, these products can also take a long time to reach the treatment goal, often requiring sharp debridement in conjunction. Another negative is that these products can be very expensive and many times are not covered by insurance.
- Bio-surgical is the medical use of live maggots (fly larvae) for treating non-healing wounds. Medicinal maggots have three mechanisms of action, 1) they debride (clean) wounds by dissolving the dead (necrotic), infected tissue; 2) they disinfect the wound by killing bacteria; and 3) they stimulate wound healing. This process can be time consuming as well as not widely accepted by patients. Although it is an effective debridement tool, it is not widely utilized due to regulatory restrictions in many places.
Jetox, a high powered jet lavage treatment from DeRoyal, allows for a debridement option that is effective in removing devitalized tissues without the use of extra tools or products. Your treatment options after debridement can vary based on the needs of your patient; however Jetox gives you a debridement option that is quick, with little to no mess and has been reported by patients to be virtually painless. Jetox is effective in removing unwanted necrotic tissues which helps stimulate the wound bed for healing purposes. This product does not require or need suction due to the minimal amount of fluid necessary to get the desired results and has been assigned a CPT code that may be appropriately billed in many settings.
Jetox is ideal for use on patients who cannot tolerate sharp debridement. It can also be used in conjunction with other therapies for debridement (e.g. primary dressing choices). Clinicians have mentioned how easy Jetox is to set up and use, but more importantly they and their patients have been very impressed by the results they are seeing with their wounds!
© 2014 DeRoyal Industries, Inc. All Rights Reserved. Jetox is used under license by DeRoyal.
Theresa Alvarez, RN,BSN,CWOCN
Theresa is the wound care specialist for DeRoyal. Her primary role is to provide evidence and knowledge based information on our wound care products and to assist in sales calls, product trials and implementations.
Mile 1: The Vulnerable Ankle
November 12, 2013
I probably speak for more than myself when I say Fall is my favorite season. In addition to cooler temperatures and the beautiful changing color of the leaves, Fall means FOOTBALL! From youth to high school and collegiate to pro, thousands of athletes take to the gridiron to participate in this great American past time. Unfortunately, with the coming of Fall and football, also come injuries.
There is perhaps no other sport that places a higher demand on the body as football. While head injuries and concussions may have recently received the most attention, injuries to the lower extremity remain the most common football injury. In my twenty years of sports medicine practice and coverage of numerous high school and youth football games, injuries to the knee and ankle have by far proven to be the most prevalent and, in many cases, the most challenging conditions to manage. In addition to lost playing time for the player, these injuries pose a challenge for the healthcare practitioner working to rehabilitate the injured player and safely return them to competition.
In considering lower extremity injuries, torn ACLs (Anterior Cruciate Ligaments) and cartilage/meniscus damage that affect the knee may receive more attention due to the fact that in most cases these injuries result in surgery. However, it is the ankle sprain that is a more common problem. A sprain is the over-stretching of a ligament. Ligaments are connective tissues that connect bone to bone and are critical towards providing stability to a joint. In the case of the ankle, the lateral aspect is the most vulnerable to sprain. That said, medial sprains (primarily involving the Deltoid ligament) and high ankle sprains (involving the Syndesmotic ligaments) can also occur.
As a sports medicine clinician, my goal is to implement all the tools I have to effectively and safely return the athlete to play. In the case of a football player with an ankle sprain, bracing is a vital part of treatment. While I have and continue to tape many ankles, a quality ankle brace that can be easily donned by the player is typically included in all of my return to sport plans for injured ankles. Particular attention needs to be paid to the Subtalar joint given it is the joint in which inversion (the most vulnerable position for ankle sprains) and eversion occurs. Therefore, an effective sports ankle brace needs to incorporate design features to provide stability to this aspect of the ankle.
The DeRoyal® Element® Sport Ankle Brace with the Boa® Closure System is an excellent selection for ankle sprains and other foot & ankle related injuries. First of all, it is easy to don & doff and fits comfortably in a shoe/cleat. A brace is of no use if the player will not wear it due to poor fit or difficulty in applying it. Clinically, it provides sound Subtalar stability through its heel control strapping system and rigid medial and lateral uprights. This mimics components of a sound taping job of the ankle and protects against the all too common lateral ankle sprain. Lastly, the Boa® Closure System is unique and allows the athlete to easily adjust for a secure fit. This provides added compression to increase proprioception and comfort.
So, enjoy Fall, football, and throw a few of these braces in your training bag!
Boa® is a registered trademark of Boa Technology, Inc.
John D. Staley, III, PT, CSCS
John is a licensed Physical Therapist (PT) and Certified Strength & Conditioning Specialist (CSCS). His primary areas of practice include orthopedics and sports medicine. He is a Credentialed Clinical Instructor through the American Physical Therapy Association.
Web site: http://www.championptllc.com/