The different techniques to debride a wound
Many parameters influence the decision for debridement and especially the choice of the appropriate method. Such parameters comprise pain, the patient’s environment, patient’s choice, age, skill and resources of the care giver, patient’s quality of life, regulations and guidelines.
There are five types of non-selective and selective debridement methods⁽¹⁾, but before debridement, ask yourself or your patient these few questions⁽²⁾: Has the patient had a previous chronic wound history? Is your patient compliant with the plan of care? Who will be performing the dressing changes? Are there economic factors that affect the treatment plan? Take the answers to these questions into consideration when deciding on debridement methods.
It is important to have a different approach depending on the type of tissue:
- Necrotic tissue: the objective is to provide moisture in order to liquefy the tissue
- Slough: the objective is to remove the exudate and remove this fibrinous tissue
The 5 techniques are available today to debride a wound:
Biological debridement
It consists of theuse of maggots, Lucilia sericata (green bottle fly), that are grown in a sterile environment and digest dead tissue and pathogens. The sterile maggots are applied to the wound bed with a dressing used to "confine" the maggots to the wound.(3) This technique is expensive and not available in every wound care centers.
Enzymatic debridement
It is performed by the application of a prescribed topical agent that chemically liquefies necrotic tissues with enzymes. These enzymes dissolve and engulf devitalized tissue within the wound matrix. Enzymatic debridement is commonly used in the long-term care setting because there is less pain.
Autolytic debridement
this is most commonly used in the long-term care setting. There is no pain with this method. This method uses the body's own enzymes and moisture beneath a dressing, and non-viable tissue becomes liquefied. Maintaining a balance in moisture is important. Dressing types commonly used are:
- Hydrocolloids with hydrogels for the removal of necrotic tissue
- Poly-absorbent dressings for the removal of slough. Their fibers have proven their superior efficacy in a European RCT. Poly-absorbent dressings deslough 50% more wounds than hydrofiber dressings after 6 weeks of treatment⁽⁴⁾
Poly-absorbent dressings also demonstrated to:
- Trap and retain slough effectively⁽⁴⁾
- Absorb exudate with no maceration⁽⁵⁾ thus protecting the peri-wound skin
- Trap bacteria⁽⁶⁾, limiting bacterial proliferation
- Support clotting⁽⁷⁾
Mechanical debridement
This is an irrigation, hydrotherapy, wet-to-dry dressings, and an abraded technique. This technique is cost-effective, can damage healthy tissue, and is usually painful.
Surgical debridement
This technique is performed by a skilled practitioner using surgical instruments such as scalpel, curette, … This debridement type promotes wound healing by removing biofilm and devitalized tissue. Surgical debridement is the most aggressive type of debridement and is performed in a surgical operating room.
Slough in a wound is a recurrent issue for a large majority of patients. Consequently, desloughing should not be deemed a one-off process but an on-going procedure referred to as ‘maintenance de sloughing’. Maintenance desloughing will help to achieve and maintain a healthy wound bed and aid the removal of wound biofilms, facilitating wound healing⁽⁸⁾.
1. Wound Debridement Options: The 5 Major Methods from https://www.woundsource.com/blog/wound-debridement-options-5-major-methods
2. Leaper D. Sharp technique for wound debridement. World Wide Wounds. 2002. Available at: http://www.worldwidewounds.com/2002/december/Leaper/Sharp-Debridement.html. Accessed April 15, 2018.
3. Sherman RA. A new dressing design for use with maggot therapy. Plast Reconstr Surg. 1997;100(2):451–6.
4. Meaume S., Dissemond J., et al, Evaluation of two fibrous wound dressings for the management of leg ulcers: Results of a European randomised controlled trial (EARTH RCT). J Wound Care, Vol 23, No 3; March 2014, 105-116.
5. Meaume S. et al, Management of chronic wounds with an innovative absorbent wound dressing. J Wound Care, Vol 21, No 7; July 2012, 315-322.
6. Data on file Urgo, (in vitro study), report n°95576-2010, n°141263-2012.
7. Data on file Urgo, report n°88050-2009
8. S.L. Percival, L. Suleman. Slough and biofilm: removal of barriers to wound healing by desloughing. Journal of Wound Care VOL. 24, NO. 11 | Published Online: 9 Nov 2015 https://doi.org/10.12968/jowc.2015.24.11.498