Types of Debridement

Debridement is the removal of unhealthy tissue from a wound to promote healing. It is necessary for the proper evaluation and treatment of all serious wounds, whether they were caused by injury, poorly controlled infection or burns. Types of debridement vary; the attending physician decides which to use. Without debridement, infection may invade the bloodstream, leading to amputation or even death.

Mechanical

• One of the oldest methods of debridement is mechanical. In this procedure, a saline wound dressing is allowed to dry overnight and adhere to the necrotic (dead) tissue in the wound. When the dressing is removed the next day, the necrotic tissue comes off with it. This process can be very painful because the dressing adheres to both necrotic and live tissue. Wounds that have begun to heal and produce new tissue should not be debrided by this method, as it is nonselective; it can remove good tissue along with the bad and hinder the healing process.

Autolytic

• Moist dressings hold in body fluids.

  Autolysis takes advantage of the body's ability to dissolve dead tissue by using its own moisture and enzymes. Special moist dressings hold wound fluids in contact with the necrotic tissue until it liquefies; the necrotic tissue is then removed with the dressing. The obvious advantage of autolytic debridement is that it utilizes the body's own systems to cleanse the wound. Autolytic debridement is the most selective type of debridement. It removes only necrotic tissue and does not damage surrounding healthy tissue. The process involves little or no pain for the patient.

Surgical

• Surgical debridement is fast and precise.

  Surgical debridement, by scalpel or laser, is the fastest method of debridement, but it requires anesthesia and a surgeon. The advantages of surgical debridement over other methods are its speed and the degree of precision with which necrotic tissue can be excised. The surgeon decides exactly what to remove in order to halt the spread of infection and to preserve as much healthy tissue as possible. Surgical debridement is extremely effective for removing large amounts of necrotic tissue, especially when an infection is present.

Chemical

• Chemical debridement relies on enzymatic gels and solutions.

  Chemical debridement relies on topical applications of enzymatic gels and solutions that dissolve necrotic tissue. Because enzymes do not distinguish between live and dead tissue, a health-care provider (who is familiar with the enzymes and how they work) must use them with caution. Chemical debridement is useful for patients who are not healthy enough for surgery or who are in nursing homes where surgery is not an option. Chemical debridement is not a replacement for mechanical or surgical debridement when those methods are indicated.