Surgical Debridement | Wound Debridement Techniques

What is Surgical Debridement?

Surgical debridement is similar to sharp debridement in that it relies on the use of forceps, scissors, or a scalpel to remove devitalized tissue, debris or other foreign materials from the wound bed.(1–3) However, unlike sharp debridement, surgical debridement is carried out in a sterile, operating-room environment in order to reduce the risk of infection. The procedure is performed by a physician or podiatrist, whose advanced skill and knowledge allow more extensive exploration of the wound bed. The technique also allows debridement of deeper tissues than can be achieved through other means.(1)

Agressive, But Can Prevent Amputation

Surgical debridement is the most aggressive and rapid form of debridement available to clinicians.(2) It is indicated in extensive necrotic wounds as well as wounds with extensive or poorly defined undermining. Used early, surgical debridement can prevent amputation or even in some cases loss of life due to sepsis. (1)

Disadvantages of Surgical Debridement

Although surgical debridement can be highly effective in some of the most difficult to manage wounds, it does have a number of disadvantages. As with any surgical procedure, surgical debridement can cause the patient physical and emotional stress, meaning that the patient may require considerable recovery time. Even with the most skilled physician, the procedure can be imprecise, meaning that healthy tissue may be sacrificed along with necrotic matter or foreign debris. Finally, by its very nature, surgical debridement is the most resource-intensive and costly form of debridement.(1)

Considerations

Surgical debridement is not suitable for all patients, and should not be considered in very vulnerable patients who may not be expected to survive such a stressful procedure. It is also generally not used in patients receiving palliative care or when another form of debridement would be sufficient.(2)

The remaining form of debridement, biological debridement, will be the topic of this article next week.

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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.