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Integral Debridement in the Postoperative Setting: An Expert’s Perspective

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The Role of Integral Debridement

Integral debridement is an advanced approach to wound bed preparation that involves the synergistic use of multiple debridement techniques to optimize wound healing. This concept, as described by Mayer,1 emphasizes not only the mechanical removal of devitalized tissue but also the incorporation of chemical, biological, and some other novel methods (such as charged fiber-based debridement) to enhance the effectiveness of debridement and promote an optimal healing environment. Integral debridement involves utilizing different and synergistic debridement techniques and technologies together, particularly paying attention to newly available technologies, depending on the individual patient’s clinical needs and the different clinician’s skills sets and scope of practice, to best meet the patient’s treatment goals and provide the most appropriate and most timely care for the patient.2,3

From a plastic surgical and wound care perspective, integral debridement is essential in wound bed preparation and preparing complex wounds for successful surgical intervention and in managing postoperative wounds and other chronic wounds3 to promote healing. Effective wound bed preparation decreases slough, other debris, and polymicrobial colonies, helping to convert a chronic wound into an acute wound, which can significantly jump-start the healing process.4,5

Unique Considerations for Complex Wounds

From a surgical standpoint, many patients experience complex postoperative wounds. Etiologies of these wounds vary from trauma, surgical dehiscence, dermatologic and inflammatory wound conditions, cancer-related wounds, and other varied etiologies. Postoperative wounds present unique challenges, including residual necrotic tissue, microbial colony development, and impaired perfusion.4 A patient-centric approach to debridement is crucial, particularly paying attention to new evidence-based methods that may emerge, thus ensuring that state of the art state-of-the-art techniques are tailored to the wound’s characteristics and the patient’s overall health status.6

In my surgical practice, I employ a combination of sharp excisional debridement with curettes and scalpels, ultrasonic debridement, and negative pressure wound therapy with instillation and dwell (NPWTi-d). I employ many adjunctive debridement techniques as well to extend the benefit of my sharp surgical debridement in the postoperative setting, using integral debridement techniques such as wound irrigation with pure hypochlorous acid (pHA; Vashe, URGO Medical) wound solution which requires a mechanical element of usage for the concept to succeed.1,3 Additionally, newly introduced highly charged fiber dressings (UrgoClean Ag, URGO Medical) have proven effective in postoperative wound slough removal and to extend the benefits of debridement between sessions.2 These modalities work synergistically to remove necrotic tissue, manage germs in the wound bed, and prepare the wound for subsequent interventions.

Impact on Wound Healing Trajectory

Since incorporating the principles of integral debridement into my practice, particularly using some of the newly identified evidence-based methods, I have observed notable improvements in wound healing outcomes. Many of my patients experience decreased pain and increased comfort during treatment, and healing often has occurred more rapidly with fewer complications. The combination of sharp debridement with adjunctive therapies such as NPWTi-d with pHA-based cleansers used as the instillation fluid, and the addition of the highly charged fiber dressings for amplifying the effects of the surgical debridement, has been particularly effective in preparing wounds for definitive plastic surgical closure.1,4

Typical wound healing times vary depending on the wound type. Acute surgical wounds generally heal within 7 to 14 days, while chronic wounds such as diabetic foot ulcers or venous leg ulcers may take weeks to months depending on comorbidities and interventions.6 Nonhealing wounds often result from persistent microbial colonizes and slough, inadequate vascularization, and prolonged inflammation, which can stall healing despite standard wound care.2,5

Critical wound colonization plays a crucial role in delayed healing. Even in the absence of overt infection, often bacteria in a wound may create a protective environment that resists host immune responses and antimicrobial treatments. This impairs granulation tissue formation and epithelialization, leading to stalled wounds.4 Utilizing novel yet evidence-based integral debridement techniques, eg, hypochlorous acid wound irrigation to amplify the effects of sharp debridement and the application of highly charged fiber dressings to maintain bacterial balance and aid slough removal has demonstrated improved outcomes in my practice.1,3 I have also seen a decreased need for repeat surgical sharp debridement in the operating room for inpatients with complex wounds. By consistently addressing microbial burden and optimizing wound bed preparation, these advanced strategies can significantly enhance wound healing trajectories for otherwise recalcitrant wounds.

Clinical Case Study: Traumatic Leg Laceration

A 48-year-old female with a past medical history of hypertension and social history of cigarette smoking presented after a fall with a traumatic laceration to the right lower leg which was grossly contaminated. The patient had initial irrigation and suture closure of a partially avulsed skin flap by the trauma surgery team. She sustained necrosis of the distal portion of the avulsed skin flap, and I was consulted for assistance in management. 

The first picture shows the patient’s leg upon initial examination by me with necrosis of about 70% of the avulsed skin flap and cellulitis (Figure 1). She was started on intravenous antibiotics by the infectious diseases physician. 

Initial examination.

Figure 1. Initial examination.

 

The second photo is after I took her to the operating room and performed a sharp surgical debridement of the necrotic skin flap with a scalpel (Figure 2). After debridement, you can see thin soft tissue coverage of several of the deep leg tendons. She then had integral debridement postoperatively with wound irrigation with pHA solution performed with application of the highly charged fiber dressing every other day.1,2

 Image post sharp surgical debridement of the necrotic skin flap with a scalpel.

Figure 2. Image post sharp surgical debridement of the necrotic skin flap with a scalpel.

 

The next photo shows the wound at postoperative day 6 with greatly improved granulation tissue (Figure 3). The patient was taken back to the operating room the same day and had intraoperative sharp wound debridement with a curette. Then ultrasonic debridement was performed with pHA solution to prepare the wound for partial complex layered closure and skin grafting reconstruction, as shown in the next photo (Figure 4).

Day 6 postoperatively.  

Figure 3. Day 6 postoperatively.       

 

Wound prepared for partial complex layered closure and skin grafting reconstruction. 

Figure 4. Wound prepared for partial complex layered closure and skin grafting reconstruction.

 

This last photo is her at 3 weeks postoperative in the outpatient wound center, showing 95% take of her skin graft (Figure 5). The remaining open wound was treated with pHA soaks with each dressing change and the highly charged fiber dressing; the wound healed with weekly outpatient wound center visits and interval home health dressing changes. This successful outcome highlights the benefits of the integral debridement approach.1,3

Three weeks postoperatively, demonstrating 95% graft take. 

Figure 5. Three weeks postoperatively, demonstrating 95% graft take.

 

Next Steps

As integral debridement gains wider acceptance, and additional integral debridement technologies are developed, further research is needed to refine protocols and evaluate long-term outcomes. Ongoing studies are building on the already wide evidence base of the role of novel debridement adjuncts, including existing and emergent enzymatic debridement agents, to further enhance wound bed preparation.6 Additionally, clinical trials are assessing the impact of integral debridement on reducing surgical site infections and improving overall patient outcomes.4,5 

For wound care professionals, incorporating an integral multimodal debridement approach can significantly enhance patient care and wound healing success. By leveraging synergistic debridement technologies, clinicians can optimize wound bed preparation, reduce healing times, and improve the overall quality of life for patients with complex wounds. Introduction of novel agents, such as the highly charged fibers, makes the concept even more viable in terms of practical execution.1,3

 

References

  1. Mayer D, et al. Best practice for wound debridement. J Wound Care. 2024;33(Suppl):S1-S10. doi:10.12968/jowc.2024.33.Sup6b.S1
  2. Thomas DC, Tsu CL, Nain RA, Arsat N, Fun SS, Sahid Nik Lah NA. The role of debridement in wound bed preparation in chronic wound: a narrative review. Ann Med Surg (Lond). 2021;71:102876. doi:10.1016/j.amsu.2021.102876
  3. Atkin L. Understanding methods of wound debridement. Br J Nurs. 2014;23(12):S10-S12, S14-S15.
  4. Tran DL, Ren-Wen H, Chiu ES et al. Debridement: technical considerations and treatment options for the interprofessional team. Adv Skin Wound Care. 2023;36(4):180187. doi:10.1097/01.ASW.0000920660.07232.f7 
  5. Manna B, Nahirniak P, Morrison CA. Wound debridement. In: StatPearls. StatPearls; 2024. Accessed February 5, 2024. https://www.ncbi.nlm.nih.gov/books/NBK507882/
  6. Amadeh A, Mohebbi N, Amadeh Z, Jamshidbeigi A. Comparative efficacy of autolytic and collagenase-based enzymatic debridement in chronic wound healing: a comprehensive systematic review. Int Wound J. 2025;22(4):e70177. doi:10.1111/iwj.70177

The views and opinions expressed in this content are solely those of the contributor, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.