Debridement: When and Why?

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Debridement

By the WoundSource Editors

Wound debridement is a crucial strategy for addressing some of the underlying causes of wound chronicity. The wound healing process can be impacted by chronic disease, vascular insufficiency, diabetes, neurological defects, nutritional deficiency, advanced age, and local factors such as pressure, infection, and edema.1 Debridement can expedite healing when used to remove necrotic tissue, other non-viable tissue, and foreign material.2 It can also be a tool to manage biofilm. Debridement exposes the viable underlying tissue, which promotes healing.3 There are several methods of debridement; determining the best option depends on the health care setting as well as the characteristics of the wound being treated.

Debridement Methods

Debridement methods include surgical, sharp, autolytic, mechanical, biological, and enzymatic or synergistic debridement. In recent years, additional methods such as ultrasonic debridement, hydrosurgery debridement, and monofilament polyester fiber pad debridement have also been used.4 To know which method to use, health care providers should make sure they are familiar with the main debridement methods.

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Biological: Also referred to as biosurgical debridement, this method involves the use of sterile medical maggots. Live, sterile bottle fly larvae (Lucilia sericata) are introduced into the wound. Maggots develop by consuming the dead tissue without harming healthy, viable surrounding tissue. Multiple applications of larvae are often necessary because the maggots reach maturity and stop debriding within several days. Biological debridement disinfects the wound and inhibits biofilm growth.5

Surgical or sharp: Sharp debridement is also referred to as surgical debridement, and it involves the use of a scalpel or other surgical tool to cut away non-viable tissue. Surgical sharp debridement describes the process of debriding into healthy tissue, whereas conservative sharp debridement does not include healthy tissue. It can also be used to manage biofilm, but it frequently requires multiple sessions to prevent biofilm reformation. Sharp debridement is usually done while the patient is under general anesthesia, although it is not always necessary.4

Autolytic: Autolytic debridement uses the endogenous enzymes in the wound exudate to maintain a moist wound environment while the non-viable tissue liquefies; certain dressings can be used to promote this debridement method. Autolytic debridement takes much longer than other methods, and it can produce a foul odor during the process. It also presents a higher risk of wound infection, although this method is generally less painful, thus making it a good option for older patients and those receiving palliative care.

Mechanical: Mechanical debridement is a non-selective method that uses abrasive force to remove unhealthy tissue, although it often requires multiple sessions. Typical methods include wet-to-dry-dressings and pulse lavage. The wet-to-dry method is an inexpensive process, although it can take quite some time and cause the patient pain. Monofilament polyester pads may also be used during mechanical debridement.6

Enzymatic: Enzymatic debridement uses proteolytic enzymes to breakdown and dissolve the non-viable tissue. It is easy to administer topically but is not well suited for wounds with large amounts of tissue that must be removed. It can also be a slow process; if it is used employed on wound with a thick eschar, the tissue should first be crosshatched. Enzymes commonly used include collagenase-based products.7

Hydrosurgery: Also referred to as tangential hydrosurgery, hydrosurgery debrides non-viable tissue by using a high-pressure fluid jet that runs parallel to the surface of the wound. This draws devitalized soft tissues into the cutting chamber for excision and removal. It is commonly used as an alternative to sharp debridement.8

Ultrasonic: Ultrasonic debridement uses low-frequency sound waves to remove devitalized tissue through microstreaming and cavitational effects. These sound waves emulsify dead and dying tissues with microsized gas bubbles, thereby stimulating the membranes of surrounding healthy cells and rendering bacteria more susceptible to antibiotic treatment. This combination of processes debrides the wound and promotes healing.9

Combined debridement uses more than one method of debridement. It may be more successful in treating complex wounds and for finding the best way of dealing with differing pathological issues that may be identified in highly complex wounds.

Conclusion

By using the appropriate method of debridement, the clinician can greatly improve the wound healing environment and increase the likelihood of achieving closure.

May Practice Accelerator blog CTA

References
1. Fonder MA, Lazarus GS, Cowan DA, Aronson-Cook B, Kohli AR, Mamelak AJ. Treating the chronic wound: a practical approach to the care of nonhealing wounds and wound care dressings. J Am Acad Dermatol. 2008;58:185-206.
2. Frykberg RG, Banks J Challenges in the treatment of chronic wounds. Adv Wound Care. 2015;4(9):560-582.
3. Madhok BM, Vowden K, Vowden P. New techniques for wound debridement. Int Wound J. 2013;10:247-251.
4. Carpenter S, Shaffett TP Choosing the best debridement modality to ‘battle’ necrotic tissue: pros and cons. Today’s Wound Clinic. 2017;11(7).
5. Liu W, Jiang Y, Wang Y, Li Y, Liu Y. Combined debridement in chronic wounds: a literature review. Chin Nurs Res. 2013;4(1):5-8.
6. Meads C, Lovato E, Longworth L. The Debrisoft monofilament debridement pad for use in acute or chronic wounds: a NICE medical technology guide. Appl Health Econ Health Policy. 2015;13(6):583-594.
7. Smith RG. Enzymatic debriding agents: an evaluation of the medical literature. Ostomy Wound Manage. 2008;54(8):16-34.
8. Oosthuizen B, Mole T, Martin R, Myburgh JG. Comparison of standard surgical debridement versus the VERSAJET Plus Hydrosurgery system in the treatment of open tibia fractures: a prospective open label randomized control trial. Int J Burns Trauma. 2014;4(2):53-58.
9. Chang YR, Perry J, Cross K. Low-frequency ultrasound debridement in chronic wound healing: a systematic review of current evidence. Plast Surg. 2017;25(1):21-26.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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