Why Is Debridement Performed?

The body has its own means of healing a wound--filling it in, sealing it and shrinking it. These means can either restore the damaged tissue to its pre-injury condition or produce a scar. Sometimes, however, dead or dying tissue or foreign matter inside the wound can retard healing and, possibly, cause a dangerous infection. To prevent these consequences, clinicians must cleanse the wound, a process called débridement.

Definition

• Débridement is the removal of foreign material and dead or damaged tissue, especially from a wound, according to "Taber's Cyclopedic Medical Dictionary, Nineteenth Edition." To an extent, débridement happens naturally. Certain white blood cells remove germs from the wound site while the body's own enzymes dissolve fibrin clots (scabs), note Sue Huether and Kathryn McCance in their book "Understanding Pathophysiology, Second Edition." For more serious wounds, however, clinicians must perform débridement.

Purpose

• Failure to débride a wound may not only complicate healing but render the patient vulnerable to a life-threatening infection. This is largely because moist, devitalized tissue supports bacterial growth, notes the book "Medical-Surgical Nursing, Sixth Edition," by Joyce Black et al. Foreign material, such as cotton fibers, loose grit or dead or dying tissue can also complicate healing. If left in a wound, such material prolongs inflammation and increases the risk of infection, according to Black et al.

Infection

• When bacteria exceed a certain concentration (usually 100,000 per gram of tissue), the body's immune system loses control of them and infection results, observe Black et al. Infection produces increased drainage from the wound; reddening of the skin around the whole wound (not just the edges); development of purulent drainage; pain; fever; increase in the number of white blood cells (leukocytosis); and general malaise, according to Black et al. If infection invades the bloodstream, it can kill the patient.

Septicemia

• The entry of pathogenic microorganisms from an undébrided wound into the bloodstream (septicemia) can trigger a potentially fatal body-wide inflammatory response, note Huether and McCance. Responding to pathogens circulating in the blood, the immune system through a host of white blood cells can cause vessels everywhere to dilate, blood pressure to drop and, as a result, organs to dysfunction. As Huether and McCance indicate, organ dysfunction can then progress to organ failure and death.

Various Methods, One Aim

• In débriding a wound, clinicians may resort to different methods. The quickest technique--sharp débridement--requires a physician to remove devitalized tissue to the level of red, bleeding tissues, observe Black et al. Using a syringe and catheter, nurses can irrigate a wound. Alternatively, they can apply moist dressings that pick up bacteria and foreign matter as the dressings dry. They may use certain enzymes to separate dead tissue from the wound surface. Regardless of method, débridement always aims to reduce the infection and expedite healing.