A wound is damage to body tissues caused by pressure, injury, or surgery. More specifically, wounds can be bruises, scrapes, scratches, cuts, burns, pressure sores (pressure ulcers), or surgical incisions. Debridement is a natural process that occurs in all wounds and is essential to healing. Often, debridement does not occur naturally. In these cases, wound debridement is medically administered to remove dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue.
Dead tissue, slough, and debris in a wound can:
- Prevent or delay a wound’s normal healing process
- Mimic or hide infection
- Attract bacteria to the injury, increasing the risk of infection
- Prevent practitioners from assessing the extent and size of the wound, particularly problematic when determining pressure ulcer damage
- Increase odor and exudate
During wound healing, the affected area can become overrun with necrotic – or dead – tissue. This harms the body’s ability to recover and develop new skin, so debridement may be necessary to remove the dead material.
Wound debridement is essential for preparing the wound bed to promote speedy and efficient healing. Wound debridement can:
- Help healthy tissue grow
- Minimize scarring
- Reduce complications of infections
How Does Wound Debridement Work?
Sometimes, debridement occurs naturally thanks to the body’s ability to shed dead tissue. However, more often, it requires a medical procedure. Debridement utilizes methods such as surgical, chemical, mechanical, autolytic tissue removal, or maggot debridement therapy. There are two primary categories of debridement: active and autolytic.
Active debridement involves the manual removal of necrotic material via several types of procedures:
- Surgical debridement: During the procedure, a physician will remove the necrotic tissue using surgical instruments such as a scalpel, curette, scissors, rongeur, and forceps.
- Sharp debridement: Similar to surgical debridement, it involves the use of surgical scissors.
- Larval therapy: Maggots or their larvae are placed on the wound site and eat away at the dead skin, leaving healthy tissue behind.
Generally used in long-term care, autolytic debridement is the slowest of the debridement techniques. It involves the application of hydrocolloids and hydrogels to enhance moisture in the affected area to liquefy eschar, slough, and other forms of necrotic tissue, so the body will naturally dislodge the dead tissue. Autolytic dressings are virtually pain-free, non-adherent, and help promote healthy tissue growth and natural enzyme formation.
In addition to patient tolerance, another benefit of autolytic debridement is the relatively low cost compared to more extreme debridement techniques. Autolytic debridement is common in long-term wound care because it encourages the body’s natural attempts to heal itself.
Enzymatic debridement involves the application of a prescribed topical agent that chemically liquefies necrotic tissues with enzymes. These enzymes dissolve and engulf devitalized tissue within the wound matrix. This method often coincides with surgical and sharp debridement and is commonly used in long-term care settings, as there is less pain and the treatment can be applied daily.
Mechanical debridement occurs by irrigation, hydrotherapy, use of wet-to-dry dressings, and the abraded technique. It is cost-effective but can damage healthy tissue and is usually painful. Wet-to-dry dressings are frowned on in the long-term care setting by state surveyors because of the options available with advanced wound care dressings.
When is Wound Debridement Necessary?
Not all wounds are well suited for debridement. For example, acute wounds typically do not require the removal of dead tissue. In contrast, chronic wounds such as leg or pressure ulcers are more likely to need necrotic material removed manually.
However, it takes a comprehensive assessment by a qualified physician to determine which procedure is required to facilitate wound healing. Factors such as the patient’s general health condition, size, and location of the wound, possibility of wound infection, and presence of exudate also come into play.
When choosing a debridement method, it’s important to consider the patient’s views and overall health. For example, it would not be appropriate to debride a pressure ulcer if the patient is in the last few days of life or if debridement will increase pain.
A healthcare practitioner must also assess whether the patient’s circulation is healthy enough to support healing post-treatment. If it is unlikely that the wound will heal, treatment should focus on reducing the symptoms, such as odor or heavy exudate.
If you have questions or want to learn more about wound debridement, please feel free to contact us.