by Samantha Kuplicki, MSN, APRN-CNS, ACNS-BC, CWS, CWCN, CFCN
Part 1 in a series exploring topics related to negative pressure wound therapy application.
by Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS
There are four main types of debridement: mechanical, autolytic, enzymatic, and surgical. Each has its own advantages and disadvantages. Let’s take a look at each method individually:
Mechanical debridement is one of the oldest forms of wound debridement. This method uses a procession of moist to wet dressings, which are then manually removed. This causes non-selective debridement of necrotic tissue and slough (and sometimes healthy tissue as well). Hydrotherapy and irrigation methods are also considered forms of mechanical debridement.
Mechanical debridement is best suited to wounds with large amounts of necrotic debris. A recent advancement in mechanical wound debridement devices is the use of a monofilament fiber pad. This pad is designed to bind with slough, hyperkeratotic debris and dried exudate for removal from the wound bed.
Autolytic debridement uses the body’s own processes (enzymes and moisture) to break down tough eschar and slough. It does not damage healthy skin, but breaks down dead and devitalized tissue over time quite effectively. The idea behind autolytic debridement is to keep wound fluids in constant contact with the wound. This is achieved with the use of semi-occlusive or occlusive dressings such as transparent films, hydrogels and hydrocolloids. This method can be used on stage ll or lll wounds that are not heavily exudative.
Enzymatic debridement utilizes chemical agents to break down necrotic tissue. They are most useful for debriding wounds with a large amount of necrotic or eschar formation.
Surgical debridement uses sharp instruments (such as a scalpel) or a laser to remove necrotic tissue from the wound bed, either at the patient’s bedside or in an operating room under general anesthesia. This method is best for very large wounds with a lot of necrotic material and infected material.
A fifth type of wound debridement is biological debridement using maggots that have been grown in a sterile environment. The maggots eat only necrotic tissue, thus this type of therapy can be thought of as selective. This method is gaining in popularity, but some patients find the method somewhat painful and their perception of maggots may stand in the way of using this method of debridement.
These methods are the common methods of debridement available today. In deciding which method is best for your patient, a careful weighing of advantages and disadvantages is necessary. Almost all of these methods can be painful, therefore pain control should also be factored in to your decision.
Editor's Note: This article was originally published on August 19, 2013 and has been updated for accuracy and comprehension.
Moore, Zena (2012). The important role of debridement in wound bed preparation. Wounds International, volume 2 issue 2. Available at: http://www.woundsinternational.com/pdf/content_10389.pdf
Strohal R, Dissemond J, Jordan O'Brien J, et al. EWMA Document: Debridement. An update overview and clarification of the principle role of debridement. Available at: http://ewma.org/fileadmin/user_upload/EWMA/pdf/EWMA_Projects/Debridement...
About The Author
Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS is a Certified Wound Therapist and enterostomal therapist, founder and president of WoundEducators.com, and advocate of incorporating digital and computer technology into the field of wound care.
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.