Wound Debridement

What Is a Debridement Procedure?

Debridement is a procedure to remove debris, foreign material, or damaged, infected, or dead tissue from a wound. The purpose of this type of treatment is to help the wound heal in a variety of ways. More than one treatment session may be needed for proper management of a wound.

Why Is Debridement Performed?

Debridement is an essential procedure to help jumpstart the healing process for wounds that are not improving (or are worsening) on their own. Typically, wounds that require this type of intervention are stuck in the first stage of healing. By removing the damaged tissue or debris from a wound through debridement, the wound is able to restart the healing process.

Wound debridement can also reduce the risk of infections for a wound, and in some cases help minimize scarring.

Is Debridement a Major Surgery?

While the treatment efforts needed will vary with the severity of each wound, debridement is generally considered to be a minor surgery. And while the process varies with each type of debridement, it is typically a minimally invasive procedure.

In most cases, debridement is technically not considered a surgical treatment, as the procedure is performed on an existing wound rather than creating a new surgical wound of its own.

When Is Debridement of a Wound Necessary?

For wounds in stasis, or chronic wounds that are infected or getting worse, debridement should be considered. Common wounds needing debridement include chronic leg or pressure ulcers such as diabetic foot ulcers. For these types of wounds, it is very difficult (if not impossible) to heal one of these types of wounds without the use of debridement. This is because new, healthy tissue is unable to grow in wounds where dead tissue is present. Dead tissue can also trap bacteria and hide the signs of infection, increasing the potential for further complications and making it easier for bacteria to spread.

Not all wounds require debridement, however it is usually essential for wounds that are not healing properly. You should consult a qualified clinician to determine if debridement is the best course of action for your wound.

How Do You Debride a Wound?

Given that there are many types of wounds and unique patient needs, there are several different methods of debridement that can be deployed to help aid in the wound care recovery process. Here are the most common ways that a wound is debrided:

Mechanical Debridement

One of the oldest forms of debridement is mechanical debridement, which removes unhealthy tissue by way of a moving force. A variety of methods are employed to remove debris and foreign material from the wound bed, including wet-to-dry dressings, hydrotherapy, monofilament debridement pads, pulsatile lavage, irrigation, and the use of hydrogen peroxide. While most materials used in this method are affordable and patients can be taught to change their own dressing, the process itself can be painful at times and time consuming for the patient. This method is best suited to help with wounds that have large amounts of necrotic tissue and debris.

Conservative Sharp or Surgical Sharp Debridement

With surgical debridement, surgical tools such as curettes, scalpels, scissors or lasers are used to cut away damaged or dead tissue quickly and efficiently. When the cut does not extend into the existing healthy tissue, this is considered "conservative sharp debridement" and is a minor bedside surgery. Alternatively, if healthy tissue may need to be cut as part of the procedure, it is considered to be a "surgical sharp debridement," which would be conducted by a surgeon in an operating room and would require general anesthesia.

Surgical debridement is well-suited for large wounds with significant dead tissue and infected material, and can be done with exacting precision to control the amount of tissue that is removed. Sharp, or surgical, debridement is also a common choice for treating diabetic foot ulcers.

Autolytic Debridement

Autolytic debridement leverages a patient's own phagocytic cells and proteolytic enzymes to break down dead and devitalized tissue over time.

This process uses occlusive or semi-occlusive dressings (such as transparent films, hydrogels, and hydrocolloids) to provide a moist wound environment that promotes cleaning of the wound bed and softening of the bad or dead tissue. This tissue should eventually swell up with moisture accumulation and naturally separate from the wound. Autolytic debridement is often recommended for pressure sores and noninfected wounds.

Chemical or Enzymatic Debridement

Gels or ointments with enzymatic agents are used to degrade and chemically digest necrotic tissue and other cellular debris. Medication applications are followed by dressings of the wound, and regular wound changes will carry away dead tissue upon removal. While enzymatic debridement is not recommended for large or severely infected wounds, it is helpful for patients with potential bleeding problems.

Biological Debridement

Although some may find it unsettling, biological debridement utilizes sterile maggots to help promote wound healing by having them eat the present necrotic tissue. In addition, the maggots also release antibacterial substances and eat harmful bacteria, which helps dispose of and keep infections out of a wound. Biological debridement is best suited for large wounds or wounds that are infected by antibiotic-resistant strains of bacteria.

Is Wound Debridement Painful?

Pain levels associated with these procedures can fluctuate depending on the type of debridement that is used. While mechanical and sharp debridement can be painful, enzymatic, autolytic, and biological debridement generally cause very little pain. In the case of mechanical and sharp debridement procedures, you will likely receive pain medication, and/or local or general anesthesia to help you through the process.

Still, most untreated wounds themselves may be causing significant ongoing pain, especially if they are infected. Any discomfort experienced through debriding is a small trade-off for the pain caused by unhealed chronic wounds.

Conclusion

If you have a wound that has not improved in a reasonable timeframe (or has worsened), a method of debridement tailored to your situation should help by removing infected or dead tissue. By removing the negative tissue within your wound, it will be primed for recovery.

Our team at Keystone Wound Care can help you determine the best method of treatment for your wound, and help you through the healing process.

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