DEBRIDEMENT METHODS

Debridement

• Debridement is the removal of dead or

contaminated tissue and foreign material
from a healable wound .

• Healability must be determined prior to

debridement.
• Debridement is a key component in wound healing. It
facilitates the removal of all foreign debris within a
wound, thereby promoting the formation of granulation
tissue and allowing for definitive wound closure.
• Debridement methods include surgical, enzymatic,
autolytic, sharp, and mechanical methods (Cervo et al.,
2000). In VIHA, biological debridement is also available
through the Foot and Leg Ulcer Clinic (Victoria – South
Island).
• It may be appropriate to use more than one
debridement method (Sibbald et al., 2000).
• Autolytic debridement is contraindicated in the
treatment of infected pressure ulcers (Cervo et al.,
2000).
• Where there is no drainage or there is boggy
surrounding tissue, leave the hard, dry eschar intact on
the lower legs, feet, or heels of those whose healing
potential is compromised by inadequate circulation. It
provides a protective base for the wound.
 Debridement Methods
Surgical Method
• Wound debris cut away by surgeon.
• Usually requires operating room time.
• Best used in large areas of necrosis and extremely
contaminated wounds.
• Also used to prepare wounds for grafting or skin flaps.
• Not recommended for malignant wounds.
• Fastest and most effective way to clean up a wound.
• Good choice for diabetics with foot ulcers.
43-year-old male with necrotizing fasciitis.
Necrotic tissue from the left leg is being
surgically debrided
• Sharp surgical debridement and laser debridement under
anesthesia are the fastest methods of debridement.
• They are very selective, meaning that the person performing the
debridement has complete control over which tissue is removed
and which is left behind
• Surgical debridement can be performed in the operating room
or at bedside, depending on the extent of the necrotic material.
• Best Uses:
• Wounds with a large amount of necrotic tissue.
• In conjunction with infected tissue.
• Advantages:
• Fast and Selective
• Can be extremely effective
• Disadvantages:
• Painful to patient
• Costly, especially if an operating room is required
• Requires transport of patient if operating room is
required
 Enzymatic Method
• Involves using enzymatic agents to breakdown
necrotic debris.
• Used on wounds prone to eschar formation and
friction-type injuries.
• Fast-acting and causes minimal damage to healthy
tissue.
• Requires prescription.
• Good choice for home care patients who find it
difficult to mobilize in order to go to a clinic.
• Enzymatic Debridement:
• Chemical enzymes are fast acting products that
produce slough of necrotic tissue. Some enzymatic
debriders are selective, while some are not.
• Best Uses:
• On any wound with a large amount of necrotic
debris.
• Eschar formation
• Advantages:
• Fast acting
• Minimal or no damage to healthy tissue with proper application.
• Disadvantages:
• Expensive
• Requires a prescription
• Application must be performed carefully only to the necrotic
tissue.
• May require a specific secondary dressing
• Inflammation or discomfort may occur
MECHANICAL METHOD
 Mechanical Method

• Physical removal of debris from a wound.

• May be used in the management of surgical
wounds and pressure, ischemic, and venous
leg ulcers.
• Advantages
• cost-effective due to the fact that gauze is the material used
• dressing changes are simple so the patient can be taught to change
their own dressing
• Disadvantages
• 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
This technique has been used for decades in wound
care. Allowing a dressing to proceed from moist to
wet, then manually removing the dressing causes a
form of non-selective debridement.
• Hydrotherapy is also a type of mechanical
debridement. It's benefits vs. risks are of issue.
• Best Uses:
• Wounds with moderate amounts of necrotic debris
• Advantages:
• Cost of the actual material (ie. gauze) is low
• Disadvantages:
• Non-selective and may traumatize healthy or
healing tissue
• Time consuming
• Can be painful to patient.
 Maggot Debridement
(Bio-Debridement, Live Debridement)
• Maggots ingest necrotic tissue.
• They are the larvae of a species of fly (calliphorids:

Lucilia sericata; also known as Pheaenicia sericata

or “greenbottle” blowfly).
• They are obtained from the University of California

(Irving).
• An import permit is required and special

instructions must be followed .

• Maggot debridement requires soft necrotic tissue.
• The benefits to wound healing include:

• selective debridement of dead tissue, cellular debris, and

serous drainage
• digestion of liquefied tissue

• antimicrobial activity of maggot secretions—ingestion of MRSA

• growth-promoting maggot secretions

• A special dressing is required to confine larvae. It must be

changed every 48 hours to evaluate progress. A decision
is then made to either provide new larvae or discontinue
the treatment (when the wound bed is clean).
• Double-bag and dispose of the dressing and
larvae as biological waste.
• Patients must be psychologically prepared to

experience this therapy. However, there is

rarely any pain associated with maggot
debridement.
MAGGOT
• Autolytic Debridement:
• Autolysis uses the body's own enzymes and moisture
to re-hydrate, soften and finally liquefy hard eschar
and slough. Autolytic debridement is selective; only
necrotic tissue is liquefied. It is also virtually painless
for the patient. Autolytic debridement can be achieved
with the use of occlusive or semi-occlusive dressings
which maintain wound fluid in contact with the
necrotic tissue. Autolytic debridement can be achieved
with hydrocolloids, hydrogels and transparent films.
• Advantages:
• Very selective, with no damage to surrounding skin.
• The process is safe, using the body's own defense mechanisms to
clean the wound of necrotic debris.
• Effective, versatile and easy to perform
• Little to no pain for the patient
• Disadvantages:
• Not as rapid as surgical debridement
• Wound must be monitored closely for signs of infection
• May promote anaerobic growth if an occlusive hydrocolloid is used
 Autolytic Method
• Do not use this method in the treatment of
infected pressure ulcers (Cervo et al, 2000).
• Uses body’s own enzymes to soften and
breakdown the eschar.
• Painless form of debridement.
• Good choice for patients with low pain tolerance.
• Slow method.
• Requires close monitoring for infection.
• Can be achieved with semi-occlusive or
occlusive dressings or with the addition of
water-based gel to wound bed.
• Used for Stage 3 ulcers, venous ulcers, and
traumatic ulcers with light eschar.
• Do not use on heavily exudating wounds.
• If tissue autolysis is not apparent in 24 to 72
hours, use another form of debridement
• Autolytic debridement: this method 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 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.
Advantages
• 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
• it is easy to perform
• very effective
• not painful for the patient
• Disadvantages
• 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