Wound debridement or debridement is the process of removing infected, damaged, dead, nonviable tissue or foreign matter wounds so as to improve the healing potential of the remaining healthy tissue.
Wound debridement can be achieved with surgery or by nonsurgical means.
Why Wound Debridement is Done?
A wound that contains tissue which is dead or infected takes longer to heal, as the body first has to destroy this burden before taking up the actual wound healing. Moreover, the necrotic tissue may become colonized with bacteria turning an uninfected wound to infected. Even the wound is not frankly infected inflammation and strain the body’s ability to fight infection may be affected. Necrotic tissue like eschar [Eschar — A hardened black crust of dead tissue that may form over a wound] may also hide pockets of pus which may cause systemic bacteremia or sepsis. Local spread of infection can lead to further loss of viable tissue endangering limb and life both.
Wound debridement takes the load of tackling the dead tissue away from the body so that the body can concentrate on healing of the wound.
Types of Wound Debridement
As previously noted, wound debridement can be done by surgical or nonsurgical means both. Different types of wound debridement are
- Surgical
- Enzymatic
- Autolytic
- Mechanical
Surgical Wound Debridement
It is also called sharp debridement. Here, the debridement is achieved by surgical means by using a scalpel, scissors, or another instrument to cut dead tissue. Mostly, it can be done bedside without anesthesia but for bigger debridements, general anesthesia or regional anesthesia may be required.
Surgical debridement method is quickest and most efficient method of debridement. It is also the preferred method of debridement in local or generalized infection originating from the wound.
Debridement procedure is generally performed by a physician. The dead tissue is removed by using a sharp cutting instrument. More than one debridements may be necessary in some patients.
Mechanical Wound Debridement
A dressing moistened by saline is allowed to dry and it adheres to the dead tissue. On removal of this dressing, the dead tissue also gets pulled.
Mechanical wound debridement is the oldest method of debridement. This method can cause pain as dressing can adhere to living tissue as well.
Chemical Wound Debridement
In chemical debridement, certain enzymes and other compounds are used to dissolve necrotic tissue. Collagenase is the enzyme that breaks down the collagen which is one of the major constituents of the skin and subcutaneous tissue.
Collagenase is commercially available and is highly effective
Autolytic Wound Debridement
Autolytic debridement is done by dressings that trap the wound fluid that contains growth factors, enzymes, and immune cells that promote wound healing.
Thus, autolytic wound debridement takes advantage of the body’s own ability to dissolve dead tissue. Autolysis causes dissolving the dead tissue by using the body’s own enzymes and only affects the necrotic tissue.
Autolytic wound debridement is achieved with the use of occlusive or semi-occlusive dressings like hydrocolloids, hydrogels and transparent films that maintain wound fluid in contact with the necrotic tissue.
Autolytic wound debridement is best used in stage III or IV wounds with light to moderate exudate.
It causes little discomfort to the patient. The disadvantage of this debridement is that it takes very long time to act.
Maggot Debridement Therapy
Maggot Debridement Therapy is done by using live maggots for treating non-healing wounds. Disinfected fly larvae are applied to the wound for 2 or 3 days within special dressings to keep them from migrating. Larvae act by dissolving dead and infected tissue.
The literature lacks large clinical studies on this issue and the studies available are quite small to give a verdict.
Debridement in Chronic Wounds
Chronic wounds can have a large amount of inflammation and produce a large amount of exudate which interferes with wound healing.
Therefore in chronic wounds, debridement not only should remove actual eschars and frankly nonviable tissue but also the removal of the exudative component.
An initial debridement phase followed by a maintenance debridement may be done for chronic wounds.
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