Debridement is the process of removing de-vitalized, or dead tissue from a wound bed. Devitalized tissue can appear yellow, tan, or black in color, and can be dry or wet. Because devitalized tissue can impede the healing process, physicians often choose to debride a wound bed as part of the treatment process.
Four methods of debridement exist. They are autolytic, mechanical, enzymatic, and surgical. The method of debridement a physician chooses often depends on the amount of necrotic (dead) tissue present in the wound bed, the extent of the wound, the patient’s medical history, and overall condition. Clinicians sometimes use debridement methods in conjunction with one another in order to provide the most accurate and comprehensive removal of dead tissue.
Surgical debridement is the removal of devitalized tissue by a physician using a scalpel, scissors or other sharp instrument. Surgical debridement remains the standard of care for removal of necrotic tissue. Physicians use surgical debridement when the tissue removal needs are extensive, or when the patient has a serious infection associated with the wound. The advantage to surgical debridement is that it is particularly selective; physicans have the ability to remove specific sections of devitalized tissue from the wound bed. Surgical debridement quickly removes the dead tissue, and may reduce the length of hospital stay for some patients. Physicians perform surgical debridement either at the patient’s bedside, or in an operating room after administering anesthesia.
Autolytic debridement is the process the body undertakes to remove dead tissue. During autolysis, enzymes present in the wound have the effect of liquefying non-viable tissue. Physicians foster autolytic debridement by utilizing moist wound dressings. By maintaining a moist wound environment, the body is able to use its own processes to eliminate devitalized tissue. Products that are conducive to autolysis include hydrocolloids, transparent films, and hydrogels. Autolysis can be used on its own, after surgical debridement, or in conjunction with enzymatic or mechanical debridement. Autolysis is helpful for patients who cannot tolerate other forms of debridement, however, it is more time-consuming than other methods.
Enzymatic debridement encompasses the use of a topical ointment to promote debridement, such as collagenase. Physicans apply the product to the devitalized tissues in the wound bed. Like autolysis, doctors may utilize enzymatic debridement after surgical debridement or in conjunction with autolytic and mechanical debridement. Enzymatic debridement is recommended for chronic wounds. Patients feel minimal discomfort and dressing changes are simple to perform.
Mechanical debridement generally occurs when patients use dressings that adhere to wounds, which are usually wet-to-dry dressings, such as gauze. The top layer of the wound bed dries and adheres to the gauze dressing. During the removal process, the tissue that adhered to the gauze is also removed. Some of that tissue is non-viable, while some of it is viable. Physicans refer to this as non-selective debridement, because it does not discriminate between healthy and unhealthy tissue. Mechanical debridement calls for frequent dressing changes. It is useful as an initial form of debridement, or as preparation for surgery.
Last updated: 19-May-04