Types of Wound Debridement

Debridement is the removal of foreign material, devitalized tissue, or contaminated tissue from the wound bed. Debridement is an important procedure that greatly affects how a wound will heal. Necrotizing tissue has a negative effect on wound healing. Removal by medical intervention is often necessary.  Many wound dressings provide sufficient debridement without further intervention.

Wound healing is a highly integrated cellular event.  As a result, many factors must be analyzed before deciding if debridement is a viable option for your patient. There are several methods of debridement including surgical, enzymatic, autolytic, mechanical, and biological.

When selecting any dressing or debridement technique, make sure to analyze:

• The location of the wound
• The wound bed
• The wound depth
• The periwound skin
• Vascular health
• The wound occurrence (is it chronic?)
• Who will be changing the wound dressing
• Patient nutrition

The drainage and depth of the wound should dictate the type of dressing and debridement method chosen. It should also suit the condition of the periwound skin. Wounds that are poorly vascularized should not be debrided. The location of the wound will determine the suitable thickness of the dressing and the extra protection it may need. Patient adherence, including nutrition, self-administered dressing changes, or healing disruptions should also be considered.

 

Types of Debridement

The types of debridement are broken out into two categories based on how they affect tissue. Selective debridement targets the devitalized tissue onlywhile non-selective targetsthe entire wound, including healthy tissue.

• Surgical Debridement (Sharp = Selective)
• Enzymatic Debridement (Selective)
• Autolytic (Selective)
• Biological (Selective)
• Mechanical (Nonselective)
• Irrigation (Nonselective)

Surgical Debridement

Surgical debridement is sometimes referred to as excisional debridement. This type of wound debridement is the removal of tissue with forceps or scalpels. Sharp debridement is one method of surgical debridement. Sharp debridement is the removal of tissue using medical scissors. One benefit of surgical debridement is complete control over tissue removal. While this is the quickest way to remove necrotizing tissue, it can often be very painful for patients. Downsides to surgical debridement for larger wounds are surgical downtime, cost, and potential blood loss.

Enzymatic Debridement

Enzymatic debridement utilizes chemical agents to break down necrotic tissue. Typically, the enzyme is combined with a dressing that is changed regularly, which softens the tissue and allows for the necrotic tissue to be removed when the dressing is removed.

Some of the advantages to enzymatic debridement are:

• Works faster than autolytic debridement
• little risk to healthy tissue when properly applied

Some of the disadvantages to enzymatic debridement are:

• The patient must have the chemical agent prescribed and it may be relatively expensive
• It is important to ensure healthy tissue does not come in contact with the chemical agent
• A secondary dressing may be required to absorb exudate
• Enzymatic debridement may cause some discomfort to the patient (i.e., burning sensation, increased wound pain)

Many practitioners employ enzymatic debridement after surgical debridement for chronic wounds.

Autolytic Debridement

Autolytic debridement uses the body’s own defense mechanisms and fluids to liquefy eschar, slough, and other forms of necrotic tissue. Autolytic dressings are non-adherent and help promote healthy tissue growth and natural enzyme formation. Hydrogels, hydrocolloid dressings, alginates, hydrofibers, and transparent films are autolytic debridement dressings. These dressings are virtually pain-free because they do not disrupt or stick to the wound bed.

In addition to patient tolerance, another benefit of autolytic debridement is the relatively low cost compared to more extreme debridement techniques. Autolytic debridement is very common in long-term wound care because they encourage the body to try to heal itself.

Choosing the RIGHT Autolytic Dressings

Hydrogels and hydrocolloids may cause maceration of the periwound skin, making them a poor choice for high-drainage wounds. Alginate dressings are another form of autolytic debridement dressings. Alginate dressings can prevent maceration, which makes them a better choice for high-drainage wounds. Autolytic debridement is also not recommended for infected wounds.

Misdiagnosis when Using Autolytic Wound Dressings

With autolytic dressings, it is important not to mistake liquified necrotic tissue for purulent drainage, as the color and odor may be characteristically similar.

Mechanical Debridement

Wet-to-dry dressings, such as wet gauze dressings, are the most common mechanical debridement treatment. Wet gauze treatments are also a treatment option for some necrotizing wounds because they pull necrotic debris out of the wound and transfer it into the gauze.

The downsides to mechanical debridement include potential disruption of newly formed tissue. Wet-to-dry debridement may reopen healing wounds. Removal can also be painful for some patients. Compared to other debridement techniques, this one is relatively slow.  Many providers often combine mechanical debridement and autolytic debridement to speed up healing and reduce further tissue damage.

Biological Debridement

Biological debridement is the use of other organisms to facilitate debridement. The most well-known example is maggot debridement. One benefit is precision- maggots are able to consume necrotic tissue more accurately than a human eye can judge removal. One of the downsides to biological debridement is patient pain. Another downside is organism availability since this is not a common practice.

Irrigation Debridement

Irrigation uses fluid to remove wound debris topical agents, and surface bacteria. While some do not consider irrigation to be one of the core debridement categories, it is still a common debridement method. This is often followed by another method of debridement. Irrigation is a non-selective debridement technique that is quick and cost-effective.

Choosing the Best Debridement Technique

Wound debridement is not a one-size-fits-all remedy. Many chronic wounds require combined wound therapy.

Consider all aspects of the wound, including the wound bed, depth, periwound skin, present drainage, and vascular health. Also consider patient nutrition, and who will be responsible for changing any wound dressings. Patient adherence and healthcare provider’s debridement knowledge can greatly impact the prompt healing – or further decay and recurrence – of a wound.

More Resources About Debridement: 

Methods of Debridement:
Wound Bed Preparation
Serial Debridement Evidence
Debridement Training
Debridement Techniques:Biological Debridement
Debridement Techniques: Surgical Debridement
Debridement Techniques: Sharp Debridement
Debridement Techniques: Mechanical Debridement
Debridement Techniques: Enzymatic Debridement
Debridement Techniques: Autolytic Debridement

 

Sources: 

1. Wound Debridement Options: The Five Major Methods. 2018. [Link]
2. Whitlock, J. Types of Debridement of a Wound. 2018. [Link]
3. Thomas, C, Dressings for Autolytic Debridement. Advances in Skin & Wound Care Vol. 17, 222. 2004. [Link]