Guest Post by Rick Redfield, PA-C, is Director of Clinical Affairs at Telemedicine Solutions, LLC
Skin debridement is not a new wound care technique.
The term dates back to the 18th century when French surgeons would make incisions on the surface of the skin to relieve swelling. While the instruments behind the technique have improved the core concept remains the same—to reduce swelling and promote healing.
Modern medicine debridement may include removing necrotic tissues, foreign debris, bacteria or other devitalized tissue from the wound area. Tissue that is transitioning from viable to devitalized tissue is called slough. Tissue that is completely non-viable is called necrotic tissue. Necrotic issues take on different forms including eschar. Although eschar usually appears dark with a leather-like texture, eschar could also appear spongy. The build-up of any devitalized tissue inhibits the production of normal healthy granulation tissue and provides a breeding ground for bacteria to grow. It also can result in the immune system initiating an inflammatory response.
There are a number of techniques used to debride a wound:
This method uses the body’s own enzymes and moisture to re-hydrate, soften and finally liquefy hard eschar and slough. This process affects only necrotic tissue. Another advantage is that it is relatively painless for the patient. Proper dressing selection will promote a moist wound bed that can result in autolytic debridement.
This technique has been used for many years in wound care and is often superseded by better methods. The classic example is called “wet-to-dry” where dressings of ordinary gauze are moistened and applied to a wound. When the dressing dries and is removed, devitalized tissue adheres to the gauze and is pulled away. This can be very uncomfortable for a patient and in the era of advanced wound care has limited applications.
Enzymes are naturally occurring agents that can break down devitalized tissue. They can be incorporated into products that can be applied to wounds to act on necrotic tissue. This method works best on any wound with a large amount of necrotic tissue. This method can be very effective but also can be expensive and needs to be monitored closely for best results.
Surgical debridement is sometimes called “sharp debridement” and can be accomplished with scalpels or lasers, and is usually reserved for wounds where other methods have failed or are not tolerated. This procedure is usually accomplished with some form of local anesthesia. The process is selective as the clinician can remove only the tissue intended to be debrided. Surgical debridement can be performed in the operating room or at bedside, depending on the extent of the devitalized tissue. This method works best on wounds with a large amount of necrotic tissue in conjunction with infected tissue. Once the offending tissue is removed, the natural process of wound healing can occur unimpeded.
Debridement has many potential benefits including the restoration of a healthy base (wound bed) for healing, the drainage of abscess and in some cases, even eliminating odor. While debridement is an effective tactic in some cases, it is not always the correct wound care tactic.
Prior to making the decision on debridement, healthcare professionals must decide if the patient’s wound requires debridement to promote healing, and select the appropriate method based on the specific wound criteria and the patient’s overall health. Debridement is then used in conjunction with other established methods of wound care such as proper dressing selection to promote a healthy wound healing environment. Properly applied, this powerful technique can make the difference between rapid and complete healing or a stalled, chronic wound that resists improvement.