2 The technology

Description of the technology

2.1 The Debrisoft range (L&R Medical UK) are sterile and single-use monofilament debridement devices intended for nurses and other healthcare professionals to use on adults and children to remove devitalised tissue, debris, and hyperkeratotic skin around acute or chronic wounds. They are made of monofilament polyester fibres with a reverse side of polyacrylate. The monofilament fibres are cut with angled tips designed to penetrate irregularly shaped areas and remove devitalised skin and wound debris. There are 2 sizes of pad (10 cm × 10 cm and 13 cm × 20 cm, both with a hand pocket to facilitate handling) and a version with a handle (Debrisoft Lolly). [2019]

2.2 The Debrisoft pad is moistened with tap water, sterile water or saline, folded and then, using the soft fleecy side, wiped across the wound with gentle pressure. Cellular debris, slough tissue, exudate and hyperkeratotic tissues become integrated into the monofilaments and are removed from the wound site. The Debrisoft pad is intended for use without analgesia, and the process takes, on average, 2 to 4 minutes. A new pad is normally needed for each separate wound being treated. For large areas, more than 1 pad may be needed.

2.3 The cost of 1 Debrisoft monofilament debridement pad stated in the sponsor's submission in August 2013 was £6.19 and is currently £6.27 (both excluding VAT).

2.4 The claimed benefits of the Debrisoft pad in the case for adoption presented by the sponsor are:

  • reduction in pain associated with debridement with no analgesia required in most cases

  • improved acceptability to patients with reduced fear and anxiety associated with treatment

  • faster treatment and healing with reduced frequency and total episodes of care

  • reduced risks of trauma to healthy tissue, and of bleeding

  • reduced time and resources associated with debridement and reduced overall time to healing

  • use by nurses and other healthcare professionals in the community leading to lower costs and shorter waiting times for treatment

  • more effective debridement facilitating initial assessment with the possibility of reduced referrals, hospital administration and inappropriate treatment through misdiagnosis

  • improved patient concordance with reduced costs of analgesia often required with other forms of debridement

  • avoidance of ongoing costs relating to specialist methods of debridement and treatment that require additional consumables.

Current management

2.5 Debridement is the removal of dead, damaged tissue or haematoma from a wound. Several techniques are used for debridement, depending on the nature of the wound. In the community these are likely to include mechanical, autolytic and biosurgical techniques. Debridement can be carried out with or without analgesia depending on the degree of wound pain, the site, size and severity of the wound as well as the patient's preference.

2.6 The NICE guideline on pressure ulcers states that standard practice in the management of chronic wounds includes wound debridement to remove dead tissue, and that clinicians should recognise the potential benefit of debridement in the management of pressure ulcers. NICE includes the technique of debridement in the NICE Pathway on pressure ulcers. [2019]

2.7 The NICE guideline on diabetic foot problems recommends that diabetic foot ulcers can be managed using debridement. The guideline states that debridement should be performed only by healthcare professionals from a multidisciplinary foot care team, using the technique that best matches their specialist expertise, clinical experience, patient preference, and the site of the ulcer. [2019]

2.8 The clinical pathway for people with burns or with surgical wounds that have ruptured (dehisced) is not well defined and varies by wound type. Treatment for dehisced wounds may include antibiotics, wound packing, and negative pressure wound therapy. Haematomas with overlying necrotic skin can be treated conservatively using autolytic, larvae or honey debridement. If the haematoma is very large, surgical debridement and treatment may be needed dependent on depth, severity, size, position and patient-related factors.

  • National Institute for Health and Care Excellence (NICE)