What Is Selective Debridement?

Debridement is the removal of necrotic or unhealthy tissue from a wound in order to promote healing. Debridement restarts the healing cascade, manages odor and reduces the chance for infection by removing bacteria. Selective debridement is the targeted removal of unhealthy tissue only, unlike non-selective debridement, which may remove healthy tissue, thus making the wound appear larger and causing pain. Four main methods of selective debridement exist: autolytic, enzymatic, surgical and biological. The method indicated is based on the wound type, pain level and situational urgency.

Autolytic Debridement

• Autolytic debridement is the natural and highly selective process by which the body's own enzymes break down necrotic tissue and is the easiest and least painful. This process of natural healing can produce large amounts of exudate, which consist of growth factors, immune cells and dead tissue. While this method is preferred, it typically takes the longest and is further slowed in those with circulation impairment and in the immunocompromised patient. Occlusive dressings containing a hydrogel to soften and break down necrotic tissue combined with a covering to provide a moist environment that traps this healing wound fluid are used to support the body's natural process. However, autolytic debridement is inappropriate for wounds that have become infected.

Enzymatic Debridement

• Enzymatic debridement is a pharmaceutical re-creation of the body's natural autolytic debridement process. A variety of topically applied ointments have been developed from naturally occurring bacteria and proteolytic enzymes that are applied to a wound to support the body's autolytic activity. However, some enzymes are more selective than others. Collagenase-based debridement is the most selective because it targets triple helical collagen exclusively and will not degrade any other proteins.

Surgical Debridement

• Surgical or sharp debridement is the fastest way to remove dead tissue. However, it is invasive, less selective and can cause pain, thus requiring the use of an anesthetic. It is indicated for large, deep tissue damage, painful wounds and urgent situations. Damage to viable tissues and bleeding often occurs during the procedure though it may serve to stimulate growth and healing factors. Surgical debridement is typically performed in conjunction with other debridement techniques.

Biological Debridement

• Biological debridement is the use of sterile fly maggots to digest necrotic tissue. They debride the wound by digesting dead tissue without damaging the healthy tissue while stimulating proteolytic enzyme production. This method has proved to be effective, but it is not widely used due to its psychological and aesthetic barriers.