Introduction

Effective wound management often requires attending to multiple aspects of the wound itself, including properly preparing the wound bed and managing moisture and exudate, among other facets of wound care. Tissue viability is another crucial aspect of wound management. Unfortunately, many types of wounds, including acute and chronic wounds, contain devitalized tissue. Devitalized tissue inhibits healing in multiple ways. It can serve as a source of nutrients for bacteria, especially if the tissue is necrotic. Devitalized tissue also acts as a physical barrier for re-epithelialization, thereby preventing topical compounds from penetrating the wound bed when required.¹ Further, this tissue can prevent angiogenesis, granulation tissue formation, epidermal resurfacing, and standard extracellular matrix (ECM) formation. It can also cover the wound and render it difficult for clinicians to assess the extent and severity of the wound adequately.¹

Benefits of Debridement

Debridement can remove the devitalized tissue and limit its potential negative effects on wound management. The benefits of debridement include¹:

• Removal of a potential source of sepsis
• Removal of local infection
• Decrease of bacterial burden and reduced probability of resistance from antibiotic treatment
• The ability to obtain accurate cultures and collect deep cultures after debridement to evaluate persistent infection
• Stimulation of the wound bed to prepare for healing or applying a skin graft or flap

Debridement Methods

Wound debridement is one of the most important treatment strategies for effective wound management, particularly if biofilm is present. There are multiple methods of debridement, each with a different mechanism for removing devitalized tissue, including:

• Sharp debridement: This method requires a medical professional to remove devitalized tissue surgically. It is often painful and highly invasive, but it is also the fastest method of removing devitalized materials.²
• Autolytic debridement: This method uses the body’s endogenous enzymes to liquefy devitalized tissue, although it is not recommended for wounds with excess amounts of nonviable tissue or infected wounds.¹
• Enzymatic debridement: Also known as chemical debridement, this method is similar to autolytic debridement, but rather than the body’s enzymes, it uses proteolytic enzymes.³
• Biological debridement: This method uses live, sterile bottle fly larvae, which are maggots that consume devitalized tissue without harming the surrounding healthy tissue. It is a painless way to remove large amounts of devitalized tissue.⁴
• Mechanical debridement: This method uses materials such as gauze, wet-to-dry dressings, tissue irrigation, and monofilament polyester pads to remove unhealthy tissue with force.⁵

Debridement in most wounds is considered a standard approach to wound management because it removes necrotic tissue, bacteria, and senescent cells. It also stimulates the activity of growth factors. Further, wounds with devitalized tissue that progress to infection can benefit from debridement.¹¹ Removing the source of infection can return the wound to the inflammatory phase and allow the wound to progress through the normal phases of healing. Because there are many different types of debridement and devitalized tissue, the choice of a debridement technique is important and should be based on clinical indicators. Factors to consider include⁶:

• The location of the wound
• The wound bed
• The wound depth
• The periwound area
• Vascular health
• Wound occurrence (chronic vs acute)
• The skill level of the individual changing the dressing
• Patient nutrition
• Exudate level

Other comorbidities and patient preferences should also be factored into selecting the right form of debridement. The management of complex wounds by a multidisciplinary team of clinicians may include a surgeon, a wound care nurse, an infectious disease specialist, a physical therapist, a registered dietitian, and an internist, who can all help improve wound care outcomes. Some wounds may take months to heal and require multiple treatments with debridement or the combination of several different debridement methods.¹ However, when debridement is performed correctly and patients adhere to additional treatment recommendations, this procedure can lead to enhanced wound healing, even in chronic or complex wounds.⁶

References

1. Manna B, Nahirniak P, Morrison CA. Wound Debridement. StatPearls Publishing.2018. PMID: 29939659.
2. Kataoka Y, Kunimitsu M, Nakagami G, et al. Effectiveness of ultrasonic debridement on reduction of bacteria and biofilm in patients with chronic wounds: a scoping review. Int Wound J. 2020;18:176-186. Accessed March 9, 2022. https://doi.org/10.1111/iwj.13509
3. Oosthuizen B, Mole T, Martin R, Myburgh JG. Comparison of standard surgical debridement versus the VERSAJET Plus Hydrosurgery system in the treatment of open tibia fractures: a prospective open label randomized control trial. Int J Burns Trauma. 2014;4(2):53-58.
4. Carpenter S, Shaffett TP. Choosing the best debridement modality to ‘battle’ necrotic tissue: pros and cons. Today’s Wound Clinic. 2017;11(7).
5. Meads C, Lovato E, Longworth L. The Debrisoft monofilament debridement pad for use in acute or chronic wounds: a NICE medical technology guide. Appl Health Econ Health Policy. 2015;13(6):583-594.
6. Swezey L. Types of wound debridement. 2018. WoundEducators.com. Accessed February 24, 2022. https://woundeducators.com/types-of-wound-debridement/