Wound Debridement Techniques
This week, in a continuation of our series on wound debridement techniques, we turn our attention to enzymatic debridement.
Like autolytic debridement which we covered last week, enzymatic debridement relies on the use of enzymes to remove devitalized tissue.(1–3) However, in this case the enzymes are supplied externally (exogenously) rather than internally from the body (endogenously).(1,2) Three main types of exogenous enzymes are available for enzymatic debridement; namely, proteolytics, fibrinolytics, and collagenases.(1) The choice of enzyme required to solubilize the necrotic tissue in a specific wound is usually based on a combination of previous experience and enzyme availability, rather than on the limited research evidence available.
Enzymatic debridement is a selective technique which requires less skill, but a greater overall length of time, than sharp or surgical debridement. The technique is often used in patients who cannot tolerate sharp debridement or as an adjunct to sharp debridement, and is common in home care or long-term care settings.(1–3) The technique should not be used on wounds with exposed deep tissues, facial burns, or any wound requiring more rapid debridement. Exogenous enzymes should not be applied to wounds subject to autolytic debridement.(1)
The area of eschar should be cross hatched before application of a enzymatic debridement product to encourage deeper penetration, then the product should be applied according to the manufacturer’s guidelines.(1) As most enzymes work best in a moist environment, the wound should be kept covered after application. Sometimes a prophylactic antimicrobial therapy is also recommended, and in all uses of enzymatic debridement the clinician should remain vigilant for signs and symptoms of infection.(1)
Next week, we will look at mechanical debridement.
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- Myers BA. Wound management principles and practice. 2nd ed. Upper Saddle River, NJ: Pearson; 2008.
- 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.
- Ramundo JM. In: Bryant RA and Nix DP. Acute and chronic wounds. Current management concepts. 3rd ed. St Louis, Missouri; Mosby Elsevier; 2007.