Wound Debridement Techniques 1: Autolytic Debridement

Welcome to the second in the series of articles on debridement in wound management. Last week, we kicked off this topic with a general overview of debridement and its role in wound management. Over the coming weeks, we will review each of the major techniques used for debridement, beginning this week with autolytic debridement.

Works With the Body

Autolytic debridement describes the process in which the body uses its own wound fluids, rich in endogenous enzymes, neutrophils, growth factors, and macrophages, to digest necrotic tissues.(1–3) The process is promoted by the application of a moisture-retentive dressing, such as a hydrogel sheet, semi-permeable foam, or hydrocolloid, which is left in place for several days. The wound fluid trapped beneath the dressing softens and liquefies the necrotic tissue, while growth factors and inflammatory cells within the wound encourage and hasten the early phases of wound healing.(1)

Least Invasive Wound Debridement

Autolytic debridement is the least invasive and painful method of debridement and is therefore popular among patients. The technique is particularly useful for patients who cannot tolerate other forms of debridement, and is especially common in home-care and long-term care settings and among patients receiving palliative care.1However, autolytic debridement is not appropriate for all types of wound. The technique should not be used on infected or deep cavity wounds; nor is it appropriate for gangrene or necrotic tendon, or other conditions requiring sharp or surgical debridement.(1)

Cost-Effective but Limiting

Because autolytic debridement is based on endogenous enzymes, the technique is relatively cost-effective and avoids introducing any potentially cytotoxic substances to the wound bed. However, a limitation of the technique is that it requires several days to take effect, and precludes any visualization of the wound bed during the process.(1)

Next week, we will turn our attention to enzymatic debridement.

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References

1. Myers BA. Wound management principles and practice. 2nd ed. Upper Saddle River, NJ: Pearson; 2008.
2. Ayello EA, Baranoski S, Cuddigan J, Sibbald RG. Wound Debridement. In: Baranoski S, Ayello EA, eds. Wound Care Essentials: Practice Principles. 2nd Edition. Lippincott Williams & Wilkins, Ambler PA. 2008.
3. Ramundo JM. In: Bryant RA and Nix DP. Acute and chronic wounds. Current management concepts. 3rd ed. St Louis, Missouri; Mosby Elsevier; 2007.