Wound Bed Preparation: Debridement

We’ve already discussed the importance of a healthy wound bed, which lays the foundation for wound care product effectiveness. And we’ve covered the first step in wound bed preparation, otherwise known as the restoration of the bacterial balance. 

 

The next step in wound bed preparation is the elimination of nonviable tissue, a process known as wound debridement.

 

Why is debridement necessary?

Nonviable tissue is often necrotic and includes both eschar (dried-out tissue, forming a thick, leathery texture) and slough (yellow and fibrinous necrotic tissue). Removal of necrotic tissue, also known as debridement, is necessary in order to address the bioburden levels in the wound bed, stimulate growth factor activity, and eliminate senescent cells and hyperproliferative nonmigratory tissue. When addressed correctly, the former two help in healing, while the latter, when not addressed, impairs healing. The goal of debridement is to remove necrotic tissue while preserving the healthy tissue. Necrotic tissue can accumulate continually, a process that in turn requires continuous debridement.

Debridement methods

Debridement, which is technically the process of removing devitalized tissue and foreign material from a wound, can be achieved with a variety of techniques, including autolytic, biosurgery, enzymatic, mechanical, and surgical. Autolytic debridement gets rid of nonviable tissue by promoting the activities of phagocytic cells and endogenous enzymes. Biological/biosurgical debridement relies on the use of inoculating larvae that feed on the necrotic tissue in the wound. Enzymatic debridement uses exogenous agents such as proteolyic enzymes to digest necrotic tissue. Mechanical debridement utilizes gauze, which is allowed to dry on the wound and then removed (with the dead tissue adhered to the material). Hydrotherapy is also a type of mechanical debridement. Surgical debridement is just how it sounds, removing the necrotic tissue with a sharp instrument, or via ultrasound or hydrosurgery.

Determining the best debridement method

The type of debridement used depends on the patient’s overall condition and their individual treatment plan, as well as the size and position of the wound, wound etiology, the wound bed tissue involved, and moisture levels. Also taken into account are the patient’s pain tolerance, and the time available for the procedure. With chronic wounds, debridement is often conducted over a number of weeks and requires more than one method.

 

Wound care management is undergoing rapid changes in which new information becomes available constantly. At wound educators.com, we are committed to providing you with the latest, most up-to-date evidence-based knowledge available.

If you are interested in becoming a certified wound care specialist, visit www.woundeducators.com to learn how easy it is to take your career to the next level.

 

Elizabeth A. Ayello, PhD, RN, ACNS-BC, ETN, FAPWCA, FAAN (2009). The TIME Principles of Wound Bed Preparation. Retrieved April 15 from www.woundcarejournal.com.

 

Chuck Gokoo, MD, CMO CWS, FACCWSa (2009). A Primer on Wound Bed Preparation. Journal of the American College of Certified Wound Specialists. 1, 35–39.

 

Cathy Thomas Hess, BSN, RN, CWOCN (2008). Meeting the Goal: Wound Bed Preparation. Advances in Skin & Wound Care (www.woundcarejournal.com). Vol 21, No. 7, Page 344.

 

Kathryn Vowden RGN, DPSN(TV) & Peter Vowden MD, FRCS (2002). Wound Bed Preparation. Retrieved April 14 from www.worldwidewounds.com.