Wound Debridement and is it Necessary?

There is no saying when one becomes wounded. A wound can be caused by a cut, or a blow, or any other type of impact, during which the skin gets cut or broken. Some wounds take time to heal while others heal rather quickly. During the process of wound healing, sometimes the affected area can become infested with dead or necrotic tissue. This can be dangerous to the body’s ability to recover and grow new skin. This is why wound debridement is required in order to remove all the dead material surrounding the affected area of the wound. Debridement helps prepare the wound bed to allow speedy and effective healing. Read on to know what exactly is wound debridement and is it necessary or not?

What is Wound Debridement?

What is Wound Debridement?

Wound debridement refers to the removal of dead or necrotic, or even infected skin tissue, to allow a wound to heal properly. Wound debridement is also done in order to remove any foreign material from the tissue surrounding the wound.(1)

The process is important because, with the necrotic tissue surrounding the wound, the wound will not be able to get better. Generally, these wounds become trapped in the very first stage of healing itself, and only when the dead or infected tissue is removed, will the wound restart the healing process again.

The process of wound debridement can do the following:

  1. Minimize scarring
  2. Help healthy tissue to grow
  3. Lower the chances of complications or infections

Is Wound Debridement Necessary?

Is Wound Debridement Necessary?

Wound debridement is absolutely necessary as it promotes and kick starts the wound healing process. When there is dead skin surrounding the wound, it inhibits the growth of healthy new tissue. This also makes the wounded area much more susceptible to infection. Necrotic tissue can also sometimes hide the signs of infection, as dead skin tissue increases odor and makes it easier for bacteria and any other harmful invaders to spread and enter the body from the affected area.

Debridement, though, is not a requirement for all wounds. It is usually only used for old wounds that are not healing properly. Wound debridement is also sometimes used for chronic wounds that are continuously becoming infected and getting worse with time. Wound debridement also becomes necessary if you are at risk of developing complications or problems from wound infections.

In some cases, wound debridement might be needed for both new and severe wounds.

Types of Wound Debridement

Your doctor determines the best type of debridement for your wound depending on the following factors:(2)

  • Wound type and severity of the wound
  • Your age
  • Your overall health
  • And the risk for complications

Typically, a wound debridement requires a combination of below-mentioned methods:

Mechanical Wound Debridement

Mechanical wound debridement is the most common type of debridement technique used by doctors. This technique removes the unhealthy and dead tissue with a moving force.(3) There are three major types of mechanical wound debridement, including:

Hydrotherapy: This mechanical wound debridement method makes use of running water for washing away the old tissue. This might involve a shower treatment, a whirlpool bath, or even a catheter and syringe tube.

Monofilament Debridement Pads: This wound debridement method uses a soft polyester pad, which is gently brushed across the wound. The pad helps in removing the dead tissue and other wound debris.

Wet-To-Dry Dressing: In this method, wet gauze is applied to the wound and once it dries up and gets stuck to the wound, it is physically removed, taking away the dead tissue with it.

Autolytic Wound Debridement

Autolytic wound debridement makes use of the body’s own enzymes and natural fluids for softening the dead tissue. This is carried out by using a moisture-retaining dressing that needs to be changed at least once in a day. When the moisture accumulates, the old and dead tissues start to swell up and eventually separates from the wound.(4)

Autolytic wound debridement is typically the best method for treating pressure sores and non-infected wounds. However, if you already have an infected wound that is being treated, then you can still get an autolytic debridement carried out, but it will typically be accompanied with another form of wound debridement.

Enzymatic Wound Debridement

Also known as chemical wound debridement, enzymatic wound debridement makes use of a gel or an ointment that is enriched with enzymes that work at softening the dead and old tissue. The enzymes are usually taken from a plant, bacteria, or an animal.(5)

The medication is applied on the wound at least once or twice every day and the wound is then covered with a dressing. The dressing is also changed regularly. When the dressing is removed, it takes away the necrotic tissue.

Enzymatic debridement of a wound is usually recommended if you have certain bleeding problems or if you are at high risk for surgery complications. This method of debridement is not recommended for severely infected and large wounds.

Biological Wound Debridement

Biological wound debridement makes use of sterile maggots to help wound healing. The species commonly used in this process is the Lucilia sericata species, which is the common green bottle fly. Due to this, this method of wound debridement is also sometimes referred to as maggot debridement therapy, biosurgery, and larval therapy.

The maggots of the species Lucilia sericata promote wound healing by eating away at the necrotic and old tissue. The maggots further help control infection by eating any harmful bacteria and by releasing antibacterial substances on the surface of the wound.

How does the process work? The maggots are sometimes either placed directly on the wound or in a mesh bag, which is typically kept in place with a dressing. The maggots are left there for 14 to 72 hours and are replaced at least two times in a week.

Biological wound debridement is recommended for wounds that are either infected by any antibiotic-resistant strains of bacteria such as MRSA or are very large. This method is also used if you are unable to undergo surgery due to any underlying medical conditions.

Surgical Sharp and Conservative Sharp Wound Debridement

Sharp wound debridement is a technique that promotes wound healing by getting rid of unhealthy tissue. The method involves cutting off the dead tissue.

Surgical sharp wound debridement process makes use of surgical equipment to cut off the tissue. In some cases, the cut may also include some healthy tissue around the wound. This method is only carried out by a trained surgeon and needs to be performed under anesthesia.

On the other hand, conservative sharp debridement makes use of scissors, curettes, or scalpels to cut off the tissue. The cut made in this technique does not extend to the surrounding healthy tissue. It is a minor bedside surgery and is usually performed by a nurse, family doctor, dermatologist, or even a podiatrist.

In most cases, sharp wound debridement is not the first choice for doctors. Sharp debridement is often only done is other methods of wound debridement has not worked or if you require urgent treatment. Surgical sharp debridement is also usually used only for deep, large, or very painful wounds.

How Does Wound Debridement Work?

Before you have to go in for wound debridement, the preparation for the technique depends on the following factors:

  • Type of debridement you need to undergo
  • Your overall health condition
  • Condition of your wound
  • Preparations, before the wound debridement is carried out, may include:
  • Measurement and examination of your wound
  • Overall physical exam to check your health
  • Pain medication is given in case of mechanical debridement
  • Local or general anesthesia is given in case of sharp debridement

If you are going to be getting general anesthesia, then you will need to make arrangements for someone to give you a ride home. You will also need to fast for a certain number of hours before your procedure.

Nonsurgical wound debridement is usually done in the doctor’s office itself. A medical professional, such as a nurse, will apply the treatment, which will then need to be repeated for two to five weeks, or longer depending on your wound healing.(6)

Sharp debridement, on the other hand, is a quick procedure. During the procedure, your surgeon will use metal instruments for first examining the wound, and then the surgeon will cut out the old tissue and wash your wound. If you need a skin graft, then your surgeon will also put that in place.

Wound debridement needs o to be repeated until the wound heals completely. Depending on how your wound is healing after the first round of treatment, your next procedure might include a different debridement technique.

If you are going to be undergoing mechanical debridement, then it is likely that you will be given some pain medication to deal with the main. Biological, autolytic, and enzymatic debridement generally causes very little to no pain at all. However, mechanical and sharp wound debridement is known to be painful procedures.

As mentioned above, sharp debridement will be done only with local or general anesthesia.

It might hurt when you are getting the dressing changed and you can ask your doctor about what pain medications you can take to manage the pain.

Recovery after Wound Debridement

If you have undergone debridement surgery, then it generally takes around 8 to 12 weeks for complete recovery. This time period also depends on the size, severity, and the location of your wound. The debridement method used also makes a difference in recovery time.

Your doctor will recommend when you can join back at work and if your job involves you to use the affected area or is physically demanding, then you must make sure to inform your doctor.

Proper wound care during the recovery time period will help you recover smoothly.

Here are some things you can do to protect your wound as it heals:

Keep the dressing dry: It is important to avoid getting your dressing wet. You should avoid swimming pools, hot tubs, and cover the area with a plastic bag while taking a shower to avoid getting any water on it.

Regularly change your dressing: Changing your dressing daily or according to your doctor’s recommendations is important.

Keeping the area clean: Cleanliness is very important for avoiding infection. Remember to always wash your hands before and after you touch the wound or even the dressing.

Avoid putting pressure on the wound: You need to avoid placing any weight on your wound. If your wound is on your foot or leg, then you should use crutches for the time.

In the time being, you should also:

Avoid smoking: Smoking will only make it difficult for oxygen and nutrients to reach the wound area, slowing down the healing process. It might not be that easy for anyone to quit smoking overnight, but your doctor will help you come up with a plan that will help you avoid smoking.

Eat a healthy meal: Following a healthy diet plan will help your body get all the nutrients it needs to heal properly and smoothly.

Don’t skip your follow-up appointments: These are important and you must not skip these follow-up appointments as your doctor needs to check our wound in order to ensure that it is healing as it should and that there is no infection.

Are there any Complications of Wound Debridement?

Just like all other medical problems, there are certain complications associated with wound debridement. These include:

  • Pain
  • Bacterial infection
  • Allergic reaction
  • Irritation
  • Bleeding
  • Damage to the healthy tissue near the wound

In spite of these complications, the benefits of wound debridement, though, far outweigh these risks and there are often many wounds that actually cannot heal without debridement.

When to call your Doctor?

During the healing period, you must pay close attention to your wound. If you suspect that the wound is becoming infected, then you must contact your doctor immediately. Some potential signs of infection include:

  • Swelling
  • Redness
  • Increase in pain levels
  • Excessive bleeding
  • Fever
  • Bad odor
  • New discharge
  • Nausea and/or vomiting
  • Chills

If you have received general anesthesia during your debridement, then you should seek medical help if you notice the following:

  • Severe nausea and/or vomiting
  • Coughing
  • Difficulty breathing
  • Chest pain

Conclusion

You might need debridement if your wound is not getting better and healing on its own. The debridement procedure helps the wound heal by removing infected or necrotic tissue.

There are many ways in which debridement is carried out. It can be done with live maggots, ointments to soften the tissue, special dressings, etc. The necrotic and infected tissue can also be removed or cut off with mechanical force, such as running water.

The best method of debridement will depend on your wound and it is likely that multiple techniques are used in combination to achieve the best effect.

Recovery from debridement takes 8 to 12 weeks and during the recovery period, you should practice good wound care to allow your wound to heal properly.

References:  

  1. Beitz, J.M., 2005. Wound debridement: therapeutic options and care considerations. Nursing Clinics, 40(2), pp.233-249.
  2. Atkin, L., 2014. Understanding methods of wound debridement. British journal of nursing, 23(sup12), pp.S10-S15.
  3. Marti, M.C., 1984. Mechanical and enzymatic wound debridement. Schweizerische Rundschau fur Medizin Praxis= Revue suisse de medecine Praxis, 73(30-31), pp.927-929.
  4. Ramundo, J. and Gray, M., 2008. Enzymatic wound debridement. Journal of Wound Ostomy & Continence Nursing, 35(3), pp.273-280.
  5. Ramundo, J. and Gray, M., 2008. Enzymatic wound debridement. Journal of Wound Ostomy & Continence Nursing, 35(3), pp.273-280.
  6. Madhok, B.M., Vowden, K. and Vowden, P., 2013. New techniques for wound debridement. International wound journal, 10(3), pp.247-251.

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