Debridement is an important component of the wound bed preparation (WBP) management Model. Cause of the wound and patient-centered concerns, debridement is a necessary step in local wound care. Debridement is the removal of necrotic tissue, exudate, bacteria, and metabolic waste from a wound in order to improve or facilitate the healing process

1. Wound Debridement

2.  state the purpose of debriding a wound
 • list criteria for not debriding a necrotic wound
 describe types of debridement, including sharp/surgical,
mechanical, maggot, enzymatic,
 and autolytic
 compare the advantages and disadvantages of type of
debridement
 expertise, and healthcare system resources.
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3.  Debridement is an important component of the wound bed
preparation (WBP) management Model.
 Cause of the wound and patient-centered concerns,
debridement is a necessary step in local wound care.
 Debridement is the removal of necrotic tissue, exudate,
bacteria, and metabolic waste from a wound in order to
improve or facilitate the healing process
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4.  Accumulation of necrotic tissue usually results from poor
blood supply, a prolonged inflammatory process, bacterial
damage, or an untreated cause of the wound
 If host resistance is impaired by poor nutrition, continued
pressure damage, or other comorbidities is required to
facilitate wound healing
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5.  The removal of dead and necrotic tissue is necessary to
reduce the biological burden of the wound to control and
prevent wound infection
 Necrotic tissue (can’t removed) impedes wound healing,
result in spread of bacterial damage to deeper tissue, causing
cellulitis, osteomyelitis, septicemia, limb amputation, or death
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6.  By removing necrotic tissue, debridement creates an acute
wound within a chronic wound, restoring circulation and
allowing adequate oxygen delivery to the wound site.
 Leukocytes are the primary cells of the inflammatory process
of wound healing.
 They enter the wound and remove devitalized tissue and
foreign material.
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7.  Collaboration of local enzymes (proteolytic, fibrinolytic, or
collagenolytic) also helps to dissolve and remove devitalized
tissue
 Remodeling is part of the healing process in which the wound
restructures into its final functional image.
 An acute wound with a good blood supply and essential
nutrients generally “heals” within 14 days
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8.  Remodeling, or maturation, takes another 4 weeks, making
the total healing process about 6 weeks.
 Collagen breakdown and collagen buildup occur in equal
degrees
 Excess collagen can form a keloid or hypertrophic scar.
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9.  Dead or necrotic tissue may be loose and moist, or dry and
firm.
 Oxygen and nutrients can’t penetrate a wound that is
impaired by necrotic tissue.
 Dead tissue is the breeding ground for bacteria, and the
eschar may mask an underlying abscess
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10.  Necrotic tissue that is soft, moist, stringy, and yellow is
referred to as slough (devitalized/avascular) tissue).
 It may be white, yellow, tan, or green and may be loose or
firmly adherent
 Removing necrotic tissue restores the local vascular supply to
the wound and improves healing .Caution is indicated, all
necrotic heels should be debrided.
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11.  Pyoderma gangrenosum is one example of a wound that
should not be debrided
 Septicemia is another condition that requires serious caution
before initiating debridement.
 Chronic wound care begins with treating the cause and
patient-centered concerns, including pain and activities of
daily living.
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12.  Assess individual patients to determine whether the wound is
healable, maintenance, or non-healable.
 To assess healability, an adequate blood supply is needed
 Palpable pulses in the foot indicate a pressure in excess of 80
mm Hg and enough blood supply for healing to occur.
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13.  A maintenance wound is one that has a sufficient blood
supply unable to heal due to patient or health delivery system
factors.
 Debridement and local wound care should then be
conservative for maintenance wounds.
 A non-healable or palliative wound does not have enough
blood supply to heal; therefore, debridement should be
conservative and limited to soft slough with a local
antimicrobial
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14.  Wound bed preparation (WBP) is the management of a
wound to accelerate endogenous healing or to facilitate the
effectiveness of other therapeutic measures
 Use the DIME acronym in preparing the wound bed for
healing.
• Debridement
• Infection or inflammation
• Moisture imbalance
• Edge-non-healing
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15.  Patient-centered care should include teaching about the
purpose and usual expectations of the debriding process.
 It is vital that the patient and family understand why the
necrotic tissue is being removed.
 Epithelium needs a firm granulation base to migrate optimally
toward the center of a wound.
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16.  Mechanical
 Sharp/surgical
 Enzymatic
 Autolytic
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17.  Mechanical debridement
 Methods of mechanical debridement include wet-to-dry
dressings, hydrotherapy (whirlpool), and wound irrigation
(pulsed lavage).
 Mechanical debridement may be more painful than other
debridement methods, and the healthcare provider should
consider pre-medicating the patient for pain.
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18.  All of the mechanical methods are considered nonselective
debridement.
 Mechanical methods may be harmful to healthy granulation
tissue on the surface of the wound and lead to bleeding,
trauma, and disruption of the collagen matrix along with the
necrotic tissue.
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19.  Sharp/surgical debridement
 Includes the use of a scalpel, forceps, scissors, or lasers to
remove dead tissue.
 Sharp debridement is considered by many clinician’s as gold
standard , may cause pain
 Viable tissue may also be removed inadvertently with this
method.
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20.  Clinicians need guidance in discerning the line of
demarcation between viable and nonviable
keratinocytes at the wound edge.
 The use of sharp debridement is based on expert
opinion and clinical data.
 The removal of loose bright friable granulation tissue
from the surface of an ulcer removes fibroblasts
,bacteria leading to damage the underlying tissue.
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21.  Surgical debridement is used for adherent eschar and
devitalized or dead slough on the wound surface.
 This method can be used in infected wounds and should be
the first choice for wounds demonstrating signs of advancing
cellulitis or sepsis.
 Surgical/ sharp debridement must be performed with
extreme caution in patients taking anticoagulant medications
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22.  Enzymatic debridement
 This is considered safe, effective, and easy to perform.
 Enzymes are effective wound surface cleaning agents that
accelerate eschar degradation and debridement.
 The removal of debris helps a chronic wound move from the
inflammatory stage to the proliferative stage, resulting in
enhanced wound healing.
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23.  Enzymatic debridement is accomplished by applying topical
enzymatic agents to devitalized tissue.
 If infection has spread beyond the ulcer, immediate removal
of necrotic tissue is recommended.
 Enzymes often can be used alone, to break down the eschar
before sharp debridement, or in conjunction with mechanical
debridement
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24.  Enzymes that act on necrotic tissue are categorized as
proteolytics, fibrinolytics, and collagenases, depending on the
tissue component they target.
 Before reapplying any enzymatic agent, clean the wound with
normal saline or a wound cleanser to remove any residual
enzymatic ointment and loose wound debris.
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25.  Crosshatching without cutting deep enough to cause
bleeding, is recommended prior to applying the enzyme to let
the debriding agent penetrate into the eschar
 Apply a thin layer of enzymatic ointment onto the necrotic
tissue, cover the wound with an appropriate dressing to keep
it moist and let the debriding agent work.
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26.  Muller and colleagues found debridement with collagenase to
be quicker and more cost-effective than autolytic
debridement with a hydrocolloid dressing in pressure ulcers.
 Collagenase to reduce scarring in partial-thickness burn
wounds
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27.  Autolytic debridement
 It uses the body’s endogenous enzymes to slowly remove
necrotic tissue from the wound bed.
 In a moist wound, phagocytic cells and proteolytic enzymatic
enzymes can soften and liquefy the necrotic tissue that is
then digested by macrophages.
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28.  Autolytic debridement may take longer than other methods;
it represents a less stressful method to the patient and wound
than mechanical debridement. This method of debridement is
contraindicated in infected wounds.
 Wound fluid accumulates under the dressing, aiding in the
lysis of necrotic tissue. This method is pain-free in patients
with adequate tissue perfusion.
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29.  Maggot therapy (biological or Larval therapy)
 In this type of debridement, several applications of sterilized
medicinal maggots are placed in the wound bed or directly
into the wound so they can roam around
 Maggot therapy is believed to be by the enzymes the maggots
secrete (proteinases - degrade the necrotic tissue)digest
bacteria.
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30.  Contraindications life- or limb-threatening wound,
psychological distress or the “ick factor,” bleeding
abnormalities, and deep-tracking wounds ,osteomyelitis or
critical ischemia associated with arterial insufficiency,
 Level of pain must be considered with maggot therapy.
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31. “No one method of debridement has been proven optimal for
pressure ulcers,”
 How Much Time Do You Have To Debride?
 What Are The Wound Characteristics?
 How Selective A Method Is Needed?
 What Methods Are Permitted?
 What’s The Care Setting?
 How Much Debridement Is Enough?
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32.  Wound care essentials, practice principles by Sharon
Baranoski and Elizabeth A.Ayello : third edition
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