What is Wound Debridement?

What is non-viable tissue?

Non-viable tissue can occur as a result from inadequate local blood supply, it contains dead cells and debris, and if not treated changes colour from yellow to red to brown or black/purple as it becomes more dehydrated.  This is known as eschar – a thick, leathery structure. Eschar can be yellow, brown, leathery tissue that can change in colour as the wound either improves with the method of debridement or dies off and becomes necrotic

With any advancing eschar or necrotic tissue, consideration must be given to the reason why it exists, the vascularity of the area, or blood supply to and from the area, and what lies beneath the necrotic tissue.

What’s next?

Independence Australia stocks a large range of Wound Care products.

Types of wound debridement

Surgical Debridement

As the method suggests, the wound is debrided in an operating theatre, under anaesthetic and is appropriate when there is specialised, or extensive treatment required.  It is usually considered acute wound debridement, and a one-off approach, not part of a regular treatment plan.

Sharp Wound Debridement

Sharp debridement is performed by a medical or nurse practitioner or podiatrist.  They may use topical analgesia and debride tissue where bleeding may occur and may be the intention as well.

Conservative sharp wound debridement

Conservative sharp wound debridement, as the name suggests is just that, the approach is to remove loose or non-vascular tissue and no bleeding should occur using sterile and sharp instruments, this may be performed by a Registered Nurse who has undergone training in this procedure.

Whether or not the debridement is sharp or conservative sharp, the clinician must be clinically competent in the procedure.

Ultrasound or Hydrosurgery Debridement

A specialist may use specific equipment such as ultrasound, or high-pressure irrigation, which can be a sterile procedure and topical or general anaesthetic may used.

Mechanical Debridement

This type of debridement is where the wound is moistened by hydrotherapy or wound irrigation and then left for the dressing or wound tissue to dry.  It is a longer and potentially more painful process as the intention is for the dry tissue to be removed mechanically with the devitalised tissue underneath coming away at the same time.  In it’s simplest form a wet gauze may be applied over a wound, and when dry, the dry gauze is removed along with the embedded tissue.  This procedure is no longer widely used, but still can be useful in some instances.

Autolytic Debridement

Autolysis refers to the breakdown of necrotic tissue, provided by the body’s own white blood cells. (Bryant, 1992). Accomplished via the use of moisture retentive dressings – a hydrocolloid dressing is applied to the prepared wound bed.

The moist wound surface promotes re-hydration of the avascular tissue.  The wound fluid contains white blood cells and enzymes that break down the necrotic tissue. Time frames vary.  Think of a dry scab that perhaps has occurred due to a knee graze – the scab is tight and dry and needs to be removed.  By applying a hydrogel and then a moisture retentive dressing, the scab rehydrates and will lift off easily over time.

In some cases, the necrotic tissue is left to just lift or fall off by itself, where a moisture retentive dressing, surgical or sharp debridement may not be appropriate.  As such it will be a slower process and the tissue may be malodorous as it breaks down and eventually lifts or falls off.

Many wounds with non-viable tissue are treated conservatively. This means the use of wound products that soften the dead tissue thereby making it easier to remove form the wound.

Hydrogels are the most common and popular type of product used in this way. Hydrogels are composed of approximately 80% water and donate moisture into the wound facilitating re-hydration of non-viable tissue to complement autolytic debridement. Independence Australia offers a wide range of hydrogels which can be found on their online store. 

Chemical Debridement

This form of debridement is most common and today there are a number of chemical agents that can be used for the removal of non-viable tissue.  A healthcare professional will perform a thorough or holistic assessment of the person, their medical and social history and any other contributing factors.  They may order wound swabs and pathology to ascertain if there are any sensitivities that the wound may respond to, and ideally consider non-toxic and autolytic debridement agents that will act on the non-viable tissue, whilst encouraging healthy tissue and cells to proliferate, and the wound to heal.  In all cases, the selection of the most appropriate chemical agents should be chosen and used as part of a professional treatment plan by a healthcare professional.

Parasitic Debridement

Also known as maggot or larval therapy, the larvae are raised in laboratories.  They are applied to the wound bed and release secretions including enzymes as it digests the necrotic tissue.  Once they have had their fill, the larvae separate themselves from the wound and can be flushed from the wound bed.  This technique is quite specialised and would be instigated by a healthcare professional in a clinical environment, where the application, containment and management is supervised.

Is wound debridement painful?

This depends on the type of wound, the reason for the debridement and the type of debridement chosen.  In all cases, the healthcare professional will take this into consideration and appropriate analgesia will be considered to be administered to minimise pain and discomfort.

Can I debride a wound myself?

In most cases a review by a healthcare professional is advised – a GP, Registered Nurse, Pharmacist or Podiatrist are accessible within the community.  In the instance where a person may have a dry scab from a graze, then the application of a hydrogel or moisture retentive dressing may by all that is required to hydrate, protect and assist in wound healing.

More Wound Care Advice

Looking for more tips on managing wound care? Check out our wide range of health tips from leading health professionals.