What is Wound Debridement?

Debridement is the removal of contaminants or non-viable tissue from a wound. It is a necessary part of wound bed preparation that supports healing in many ways. Micro-organisms that cause infection thrive in wound debris and dead tissue, so removing their supportive environment significantly reduces the risk of wound infection.

Non-viable tissue is also a physical barrier, obstructing new skin growth over the wound and preventing active ingredients in applied dressings from contacting the wound bed. Without debridement, the wound does not progress beyond the inflammatory phase and may become a chronic concern. In some instances, non-viable tissue can make accurate assessment impossible.

What is non-viable tissue?

Non-viable tissue means the cells have died from lack of blood supply and will never heal. Not all devitalised tissue looks the same. Slough can be wet or dry, stringy or gelatinous, and the colour ranges from cream to tan or grey. Eschar is dry, leathery and black. Macerated tissue is white, caused by excessive moisture on the skin for prolonged periods.

To debride or not debride?

Debridement is a critical step in wound bed preparation and should be performed at every dressing change. It does not necessarily involve surgery or sharp implements. Debridement can be as simple as gently wiping some loose slough off the wound bed with a piece of gauze.

That being said, a wound completely covered by dry eschar without overt signs of infection is often best managed conservatively. The eschar is an effective biological barrier that prevents contamination and maintains a moist wound environment, facilitating autolysis.

Sharp or surgical debridement must be performed by qualified clinicians. A comprehensive and holistic assessment is required to determine the appropriateness of sharp debridement in the context of risk factors, pain and the persons’ wishes.

Types of wound debridement:

Surgical Debridement

As the name suggests, debridement is performed by a surgeon in an operating theatre, requiring the patient to have general anaesthetic. This is appropriate where specialised, urgent or extensive debridement is required. It is usually a once only intervention, not part of a regular treatment plan.

Sharp Wound Debridement

Sharp debridement is performed by a doctor, podiatrist or specialist wound nurse. They may use topical analgesia (numbing cream); however, this is usually not necessary because non-viable tissue is insensate. Some bleeding is to be expected – even desirable – as it reboots the healing process.
Conservative sharp wound debridement

Conservative sharp wound debridement (CSWD) removes only non-viable tissue, so it should not cause bleeding or pain. This procedure may be performed by a RN with competency in CSWD.

Mechanical debridement

Infected or necrotic tissue is physically removed using various non-sharp techniques and equipment. Examples include low frequency ultrasound debridement (LFUD), high pressure irrigation, hydrotherapy, or monofilament fibre pads. Another well-known method is wet to dry gauze dressings, but this can be very painful, and many consider the practice outdated.

Autolytic Debridement

Autolysis is the body’s natural response to devitalised tissue. Enzymes and phagocytes within the wound breakdown necrotic tissue. This process is aided by moisture retentive dressings and hydrogels that rehydrate very dry tissue. The time to achieve debridement depends on wound size and how much tissue is to be removed, but some improvement should be seen within a few days.

Chemical Debridement

This involves the application of chemical/antimicrobial agents to remove or control non-viable tissue and promote healing. Contemporary wound cleansing solutions, medicated gels, powders and pastes, medical grade honey are examples. Traditional antiseptics like hydrogen peroxide and bleach are no longer recommended as they as they kill the cells that are trying to heal the wound. It is always best to discuss treatment options with the relevant healthcare professional. Using an inappropriate product can significantly set back healing, and in rare cases results in severe adverse reactions.

Parasitic Debridement

Also known as maggot or larval therapy. A specific breed of laboratory raised maggots are applied to the wound. Debridement is effected through several modes of action – ingestion of necrotic tissue and bacteria, release of ammonia into wound bed that inhibits bacterial growth, and release of enzymes that dissolve necrotic tissue.

Once the larvae are finished eating, they separate from the wound and can be removed. This is a specialised technique that would be instigated by a healthcare professional in a clinical environment.

Is wound debridement painful?

This depends on the method of debridement and the individual’s medical history. Always discuss your concerns with the treating clinician before the procedure. Timely collaboration with your health care team will ensure you have appropriate analgesia to minimise pain and discomfort.

Can I debride a wound myself?

A decision to debride requires a comprehensive assessment by a healthcare professional. Seeking advice from a clinician with specialist wound management knowledge is highly recommended. This will ensure you get accurate guidance to promote timely healing and prevent complications.