Wound Debridement – Introduction

Until relatively recently, the presence of necrotic tissue such as a scab or eschar was considered a natural part of the healing process.1 It is now known that necrotic tissue has a detrimental effect on wound healing, slowing or even stopping the cascade of events that lead to eventual wound closure. Wound debridement is therefore recognized as a vital part of the management of difficult-to-heal wounds.1–5

Debridement is defined as the removal of foreign material and devitalized or contaminated tissue from the wound bed until surrounding healthy tissue is exposed.2,3  In healing wounds, debridement occurs naturally in parallel with the accumulation of dying tissues in a wound. However, when host resistance is impaired by poor nutrition, continued pressure damage, or other comorbidities such as diabetes, medical intervention is required to facilitate wound healing.3 Debridement is arguably the most important part of Wound Bed Preparation, and should not be seen in isolation but as one element to achieve healing.

Multiple techniques are used to debride wounds, and these will be reviewed in future articles. The most common techniques are surgical, conservative sharp, mechanical, high-pressure fluid irrigation, ultrasonic mist, autolysis, enzymatic, larval therapy, and autolysis. Enzymatic debridement is the application of exogenous enzymes to the wound bed in order to degrade necrotic tissue without harming viable, granulation tissue.1 Debridement can be subdivided into selective  and nonselective methods depending on whether only nonviable tissue is removed. The choice of debridement method depends on a consideration of the best way to achieve the most rapid, safe, and painless healing of the wound.

Wound debridement is a fundamental part of wound management, and an essential skill for wound practitioners.

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References

1. Gottrup F and Jorgensen B. Maggot debridement: an alternative method for debridement. Eplasty. 2011;11:e33. Epub 2011 Jul 12.
2. Ramundo J and Gray M. Enzymatic wound debridement. J Wound Ostomy Continence Nurs 2008; 35(3); 273-280.
3. 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.