Key Takeaways

• Wound debridement: Technique selection should reflect the clinician’s licensure, state practice act, comfort, and skill level. Mentorship is recommended before performing sharp debridement; alternatives include enzymatic agents, pulse lavage, and wound cleansing.
• Timing and acuity: Consider infection, pain, positioning tolerance, and visualization. Wounds causing infection may require OR surgical debridement for source control; other wounds may be debrided incrementally.
• Ongoing wound care: Debridement should be integrated with cleansers, dressings, and topicals between sessions. An interdisciplinary network can provide deeper debridement when needed.

Please note: This content is a direct transcript, capturing the authentic conversation without edits. Some language may reflect the flow of live discussion rather than polished text. 

Transcript

Hi, my name is Stephanie Woelfel. I am a doctor of physical therapy and a certified wound care specialist currently serving as an associate professor of physical therapy and surgery at the University of Southern California. 

So as far as choosing the type of debridement that you want to use, things that you need to consider include first and foremost your own comfort level and licensure as a clinician. So you need to make sure that the level of debridement that you're going to perform is something that's covered under your specific practice act whether you're a PT, a physician, physician associate, nurse practitioner—all of those have different levels of debridement that are allowed by license. You also want to make sure you're checking your state practice act. 

And then really it's your comfort level. How skilled are you at this specific debridement technique that you're going to be employing? So just because you did debridement on a pig's foot in school does not mean you're ready to jump in with sharp instruments on a patient day one. You want to get some mentoring. You want to make sure that you're building that skill set. And if sharp debridement isn't something available to you for whatever reason, understand what else there is. There's a lot of different, you know, the enzymatic debriding agents. You know, some of the other things we talked about as far as pulse lavage, really good wound cleansing are things that can make a big impact for your patients. 

So when you're thinking about timing of debridement, there's different factors that you want to consider as well. So some of it has to do with what's going on with the patient, the acuity level of that patient. Also, how quickly does that wound need to be debrided? Is the wound itself the cause of an infection? That might be something that really means that that patient needs to go to the OR and they need a surgical debridement so that we can get source control and make sure that an infection doesn't spread or get any worse. But for patients where that's not the case, really think about how much pain are they having? Can they tolerate the position that they need to be in for you to get good visualization of the wound for debridement? Is it something that you might need to do bit by bit? 

And think about when we did our debridement session back in WoundCon, we talked about synergistic effects of things, right? So think about the cleanser you're using. Think about the dressings or the topicals that you're using in between debridement sessions that might help facilitate an even better session the next time you're able to see the patient. 

I think kind of my last take home regarding debridement in general would just be to make sure that this is just a standard part of your practice. Whatever level of debridement it is that you're comfortable with and are able to perform, it has to be a mainstay for taking care of your patients and also build your network. Hopefully when you listen to the debridement session at WoundCon, you realize that an interdisciplinary team is really important. So know who your colleagues are that can help you out if you need a deeper level of debridement than perhaps you're able to provide on your own and really build that team so that your patient can get the best care possible.