Methods of Wound Debridement Protection Status
wound care 101 - wound debridement

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

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.


  • Cost-effective due to the fact that gauze is the material most frequently used for this procedure
  • Dressing changes are simple so the patient can be taught to change their own dressing


  • May remove healthy (healing) tissue as well as devitalized tissue
  • Time-consuming as the dressings must be changed often (or the patient must spend a lot of time in the whirlpool bath to achieve the desired goal)
  • Can be quite painful for the patient
  • Infection is a risk when whirlpools are used due to waterborne contamination

Autolytic Debridement

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.


  • No damage to surrounding skin; is selective for necrotic tissue
  • The process is safe because it uses the body’s natural processes to rid the wound of necrotic tissue
  • Easy to perform
  • Very effective
  • Not painful for the patient


  • The process takes time (may take days to weeks)
  • The wound must be routinely monitored for signs of infection
  • Anaerobic growth may occur when an occlusive dressing is chosen

Enzymatic Debridement

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.


  • Works faster than autolytic debridement
  • If properly applied, there is little risk to healthy tissue


  • The patient must have the chemical agent prescribed and it may be fairly expensive
  • Care must be taken to ensure healthy tissue does not come in contact with the chemical agent
  • A secondary dressing may be required to absorb exudate
  • Chemical debridement may cause some discomfort to the patient (i.e., burning sensation, increased wound pain)

Surgical Debridement

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.


  • Excellent control over what and how much tissue is removed
  • Fastest way to achieve a clean wound bed
  • Can speed the healing process


  • Not cost-effective if an operating room is required
  • General anesthesia carries its own risks
  • Painful for the patient

Other Mechanisms of Wound Debridement

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:
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:

About The Author
Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS is a Certified Wound Therapist and enterostomal therapist, founder and president of, 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.


Summarizing a single author's article on debridement is really not an ideal way to address this topic objectively. National Guidelines paint a very different picture. The AAWC guidelines at state that autolytic debridement is at least as effective as enzymatic debridement (evidence level A). Whirlpool and wet-to-dry dressings (mechanical debridement) destroy any newly forming granulation tissue, so this form of debridement is no longer recommended at all. However, sharp debridement and larval therapy are acceptable. The National Institute for Clinical Excellence (NICE) also recommends autolytic debridement for nonhealing wounds, citing safety, cost-effectiveness, acceptability, and pain relief (NICE 2001/14 guidelines). Autolytic debridement can be enhanced with foam dressings as well as the ones listed in the post, and can be used for deep wounds as well as shallow ones (NICE, AAWC). Sopata, et al,. (2002) found that high bacterial counts (including anaerobes) under occlusive foam dressings did not slow healing or result in signs of infection. However, most foam dressings are available with antimicrobial agents for added safety.

My personal preference for managing necrotic wounds is PolyMem, because it works with the body, rather than against it, to promote brisk wound healing. PolyMem tends to increase the amount of exudate when it is first applied, which upsets some in the medical establishment whose goal is to quell wound symptoms. However, by doing this PolyMem helps the body flush the debris, slough, and chronic wound fluid out the wound bed. PolyMem contains a surfactant, which helps break the bonds between the slough and the wound bed, glycerin, which pulls fluid into the wound bed, and a super absorbent starch to soak up the excess fluid. These ingredients work together like a bucket brigade to clean up the wound: I call it autolytic debridement on hyperdrive. When the wound is truly clean, the exudate levels diminish and the wound VERY rapidly heals. In addition, the ingredients work together to diminish wound pain by inhibiting the nociceptor response. Very cool!

A nice overview of debridement methods, but I would like to comment on several issues. Autolytic can be damaging to the periwound tissue from maceration. Enzymatic is not chemical debridement. It is not the most efficacious for large necrotic wounds. Collagenase is not damaging to healthy tissue. Mechanical debridement with gauze is "wet to dry" (and is not a type of dressing change, as is moist to wet). Whirlpools are - or should be - rarely used for wounds. PLWS is the treatment of choice for irrigation and debridement. Also there is a big difference between surgical and sharp debridement. Surgical is removal of viable and non-viable tissue, and is out of the scope of practice of physical therapists and nurses. Sharp, which should be included as a method of debridement, is removal of non-viable tissue only, and is in the scope of practice of all licensed physical therapists, and, depending on the state practice act, of some nurses. Thanks, Harriett

With a best regard. Beside all of the useful information you said, I also get benefit from using Tenderwet plus and Manuka honey for cleansing and debriding the wounds.

It is a nice summery but i disagree on the dry to wet except as a historical method may be.
Second the effecacy of the enzymatic deb. Is recominded and ots results is as good as all others when the case is ready for it
We are here not exculding this method or that method we only select tge best fit to every and each wound
Finnaly that report was missing the ultrasound custic wound Deb . And therapy which may be fit for all type of wound in combination with surgical in some cases

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