How much tissue needs to be debrided?

Debridement enhances wound assessment, decreases the potential for infection, optimizes wound healing and establishes earlier wound bed coverage. All necrotic tissue, slough (moist yellow, tan or gray non-viable tissue), loose eschar with underlying exudates, needs to be debrided. Frequently debridement leads to bleeding. Getting down to bleeding tissue base is usually an indication that adequate debridement was performed. Surgical debridement is the most expedient method of debridement and is very selective.

Steed DL., Donohoe D., Webster MW., Lindsley L. and the Diabetic Ulcer Study Group. Effect of Extensive Debridement and Treatment on Healing of Diabetic Foot Ulcers. J. Am. Coll. Surg., 1996, 183:61-64.

What other methods of debridement are there?

There are four methods of debridement: surgical, mechanical, autolytic, and enzymatic.

What is Enzymatic Debridement?

Enzymatic debridement is defined as the use of chemical agents, applied topically to the wound, to stimulate the breakdown of necrotic tissue. Enzymatic debridement agents degrade the protein of the native collagen. In the wound bed, collagen is the major support structure which adheres devitalized tissue to the wound bed. Enzymatic debridement is considered selective and should not cause any harm to healthy tissue either in the wound bed or to the surrounding skin. AHCPR guidelines recommend it's use in patients who are not candidates for surgical debridement or individuals who are residents in long term care facilities.

What is Autolytic Debridement?

Autolytic debridement is defined as the process by which the wound bed utilizes phagocytic cells and proteolytic enzymes to remove debris. Maintaining a moist wound bed helps to promote and enhance autolytic debridement. This process results in liquification of necrotic tissue and can result in significant wound fluid and this is a consideration when selecting the appropriate dressing. Because autolytic debridement utilizes the body?s natural process it's very selective, doesn?t cause harm to healthy tissue and there is little to no discomfort.

What is Mechanical Debridement?

Mechanical debridement is defined as the removal of foreign material and dead or damaged tissue by the use of physical forces. These may include hydrotherapy and irrigation. Also wet to dry dressings are also considered mechanical debridement. These modes of debridement are non-selective as they?re unable to differentiate between healthy tissue and necrotic tissue. It?s considered a non-selective because of healthy tissue will be damaged at the same time that necrotic tissue is being debrided.

Sibbald GR., Williamson D., Orsted HL., Campbell K., Keast D., Krasner D., Sibbald D. Preparing the Wound Bed Debridement, Bacterial Balance and Moisture Balance. Ostomy/ Wound Management 46:11, 2000.