What is debridement
Debridement refers to removal of adherent, devitalised or contaminated tissue from the wound bed⁽¹⁾ and must not be confused with wound cleansing, which is defined as the removal of dirt (loose metabolic waste or foreign material)⁽²⁾.
We define debridement as the act of removing necrotic material, eschar, devitalised tissue, serocrusts, infected tissue, hyperkeratosis, slough, pus, haematomas, foreign bodies, debris, bone fragments or any other type of bioburden from a wound with the objective to promote wound healing.
Why debridement is key to wound healing?
Non-healing acute and chronic wounds are in a stage of persistent inflammation which leads to:
- Continual accumulation of cells at the wound site
- Peri-wound oedema and increase in exudate
- Greater production of slough & other wound debris
A CLEAN WOUND IS KEY TO WOUND HEALING.
Debridement is therefore a basic necessity to induce the functional process of tissue repair, which makes it a central medical intervention in the management of acute and chronic non-healing wounds⁽¹⁾.
Debridement allows to:
- manage inflammation, thus reducing exudate level⁽⁴⁾
- reduce the risk of infection⁽⁵⁾
- proceed with the granulation stage and ensure wound healing⁽⁶⁾
Debridement is sometimes referred to as a form of wound bed preparation⁽³⁾; however, from a global perspective it becomes clear that not only the wound bed but also the wound edges and the peri-wound skin are important for the successful healing of a wound.
Targets of debridement⁽¹⁾
1/ Remove: Necrosis – Slough – Eschar – Impaired tissue – Sources of inflammation – Sources of infection – Exudate – Serocrusts – Hyperkeratosis – Pus – Haematomas – Foreign bodies – Debris – Bone fragments – Other types of bioburden/barriers of healing.
2/ Decrease: Odour – Excess moisture – Risk of infection
3/ Stimulate: Wound edges – Epithelialisation
4/ Improve: Quality of life
1. Strohal, R.,Apelqvist, J., Dissemond, J. et al. EWMA Document: Debridement. J Wound Care. 2013;22 (Suppl. 1): S1-S52.
2. Oxford English Dictionary. Available from: http://oxforddictionaries.com/
3. Gethin, G., Cowman, S., Kolbach, D.N. Debridement for venous leg ulcers. Cochrane Database Sys Rev. 2010; 7: CD008599.
4. Dowsett and Ayello, 2004.
5. Shultz et al (2003).
6. Sieggreen and Maklkebust, 1997; Gottrup, 1999.