Wound Debridement

What is wound debridement and what are its main purposes?

Removal of non-viable, necrotic tissue, eschar, or slough from a wound to create a clean wound base, remove infected tissue, decrease bacterial load, and promote healing.

What are the two main types of necrotic tissue and their characteristics?

Slough: yellow/tan, thin, mucinous, stringy. Eschar: brown/black, soft or hard, leathery, represents full-thickness tissue destruction.

What are the six types of debridement?

Mechanical, Enzymatic, Autolytic, Bio-surgical, Surgical, and Sharp.

What are the types of mechanical debridement?

Wet-to-dry dressings, Whirlpool, Pulsed Lavage, and MIST Ultrasound.

What are the drawbacks of wet-to-dry dressings despite being the #1 dressing used in the U.S.?

They remove both viable and necrotic tissue, are painful, carry higher infection risk (dispersing bacteria into the air on removal), are costly/labor intensive (3x/day), and risk maceration.

What are the risks of Whirlpool as a debridement method?

Risk for cross-contamination, increased dependent edema, and non-selective removal of tissue.

What are the advantages of Pulsed Lavage as a mechanical debridement method?

Decreases bacterial burden, increases granulation tissue and epithelialization, no cross-contamination, reduced treatment time, can be done at bedside, and safe for both clean and infected wounds.

How does enzymatic debridement work, and what is a common example?

An enzyme (commonly collagenase) is applied to digest and selectively remove only necrotic tissue; it's slow-acting (3-30 days), requires a physician's prescription, and is discontinued once the wound bed is 100% red. Example: Santyl.

How does autolytic debridement work and when is it indicated?

It uses the body's own enzymes to lyse necrotic tissue, achieved with occlusive or moisture-retentive dressings (e.g., transparent films, hydrocolloids, hydrogels); indicated for slough/superficial eschar that cannot be sharp debrided, but contraindicated with infection.

What is biosurgical (maggot) debridement and when was it FDA approved?

Intentional introduction of live, sterile maggots into a wound to selectively remove necrotic tissue while leaving healthy tissue intact; FDA approved in January 2004.

What is surgical debridement, who performs it, and when is it indicated?

Performed by an MD under anesthesia; indicated for wounds with >70% necrotic tissue, infected wounds, or life-threatening necrosis (e.g., necrotizing fasciitis); it can convert a chronic wound into an acute wound.

What is sharp debridement and how does it differ from surgical debridement?

The use of sterile scissors, scalpel, or forceps to remove necrotic tissue/callus; it is non-surgical, performed without anesthesia, conservative, and sequential — unlike surgical debridement, which requires anesthesia and an OR.

Who is qualified to perform sharp debridement?

Trained physical therapists, RNs, PAs, and MDs.

What are the contraindications for sharp debridement?

Anticoagulation use or bleeding disorder, dry eschar, dry gangrene, ABI <0.8, ischemia, clean wounds, terminally ill patients, and visible vital structures.

Why should dry gangrene not be debrided?

Because it acts as the body's own natural bandage, and if arterial circulation is poor, debriding it could cause more harm than good.

What administrative/regulatory requirements apply before performing sharp debridement?

Requires an MD order, must follow the state practice act, requires patient consent, requires an adequate level of skill/experience, and should include pre-medication and an assistant present for safety.

What pain control options are available during sharp debridement?

Topical lidocaine, oral pain meds (30 min prior), injectable pain meds (2-5 min prior), anti-anxiety meds, rest breaks, deep breathing, and distraction techniques.

What is the correct technique for performing sharp debridement?

Use forceps, a #10 or #15 scalpel, or scissors; lift eschar/necrotic tissue with forceps and cut with the scalpel/scissors held parallel to the wound bed, removing tissue in thin layers using clean technique.

What signs indicate you have reached healthy tissue during sharp debridement?

Pain and bleeding are signs of healthy tissue and signal that you should stop.

What is the difference between clean and sterile technique in wound care?

Clean technique reduces pathogen transfer using a clean field/gloves/dressings and is used for routine, low-risk wound care; sterile technique uses a fully sterile field/instruments for invasive procedures or high-risk patients, allowing only sterile-to-sterile contact.

When should you stop performing sharp debridement?

When you've removed sufficient necrotic tissue, the patient reaches pain tolerance limits, time limits are reached (to avoid fatigue), a named vital structure (tendon, bone, nerve, vessel) is exposed, excessive bleeding occurs, or you are unsure in any way.

What steps should be taken if bleeding becomes a problem during sharp debridement?

Apply direct pressure for 10 minutes using increasing layers of gauze (don't remove the last 2 layers to avoid dislodging the clot), use compression/elevation, apply topical agents (e.g., Surgical Gel Foam, silver nitrate sticks, Kaltostat), and ask for help.

What is included in post-debridement care and documentation?

Cleanse the wound with normal saline, apply an appropriate dressing, dispose of sharps properly and debrided tissue in a red biohazard bag, and document the area debrided, amount of tissue removed, patient tolerance, and use of numbing agents.