1. Wound debridement is the removal of dead, devitalized, contaminated, or foreign material from a wound to promote healing. 2. Various debridement methods are described, including mechanical, autolytic, enzymatic, surgical, hydrostatic, ultrasonic, and combinations of methods. 3. The appropriate debridement method depends on factors like the wound type, depth, and presence of infection or necrosis. The goal is to enhance healing by removing barriers and reducing bioburden.

1. WOUND DEBRIDERMENT,
HOW FAR WE KNOW IT?
DR. KHADIJAH NORDIN
Coordinator Unit Penjagaan Luka HEBHK
CCWC(Malaysia)
PGWM (on going)

2. Wound debridement
a procedure to remove dead, devitalized, or
contaminated tissue as well as necrotic tissue,
eschar, slough, pus, hematomas, hyperkeratosis,
foreign bodies, debries, biofilm, bone fragments,
or another bioburden from a wound bed.

3. Wound cleansing
“The use of fluids to remove loosely
adherent debris and necrotic tissue from
the wound surface.”

4. BIOFILM
• “a structured community of bacterial cells enclosed in a self-produced
polymeric matrix (extracellular polymeric substance-EPS) and
adherent to an inert (non-living thing) or living surface”
• Has 3 functional layer
• present in most chronic wounds and are likely to be located both on
the surface and in deeper wound layers, but may not be present
uniformly across or within the wound

7. Aim Of Debridement
Remove
• Slough, pus, necrotic tissues
• Devitalized tissue
• Foreign body
• hematomas, hyperkeratosis, foreign bodies, debries, bone fragments
Reduce
• Excessive exudate
• Order
• Bioburden/ biofilm
Enhance
• epithelization
• Advancing the wound edge
• Wound closure

8. Ultrasonic Assisted Debridement
Surgical Debridement
METHOD OF WOUND DEBRIDEMENT
Enzymatic Debridement
Autolytic Debridement
Biological Debridement
Mechanical Debridement
Hydrostatic Debridement
Combination Debridement

9. Mechanical Debridement
Process of debriding by using materials (gauze, gamgee
Bactigrass, paraffin gauze, debrisoft, debrisoft lolly) to
moisten up the dry necrotic wound (wet to dry method)
Not affective on thick eschar wound and may even wipe
out healthy wound tissues.
Wet gauze to dry necrotic tissues

10. Autolytic Debridement
Usage of hydrogels to soften the necrotic tissues.
Rehydrates tissues and necrotic tissue/eschar
Hydrogels provide moist wound bed
Example : hyzo gel, intrasite gel, cavida gel,
prontosan gel, dermacyn gel, hydrocyn gel

11. Enzymatic Debridement
Use of topically applied enzyme (proteolytic) agents to break
the non-viable tissue
Faster effect than autolytic
However, it will not destroy good tissues, granulation tissues
Using enzymes to break down proteins that
strengthen the bacterial chain wall
Example: HONEY dressing (Manuka)

12. Surgical Debridement
When: when the infection involve deep tissues with clear demarcation
between viable and non viable tissues.
Instruments : Surgical scalpel blade, disposable blade, curettege, rongeur
forceps.
Benefit : faster effect and low cost.
Contraindication: may cause excessice removal of tissues

13. Biological Debridement
Maggot therapy Leech therapy

14. From Lucillia Cuprina and Lucilia Sericata flies
Harvested and sterilized
Will only eat dead tissues/slough
Not suitable for deep cavity wound / near organ
wound
Maggot therapy

15. Leech therapy
The most interesting is to improve circulation in the legs.
Ideal for patients with severe peripheral arterial disease who
cannot be improved with revascularization
Leeches to relieve venous congestions following reattachment or
transplantation surgery of fingers, toes, ears, penis, and other
skin-flaps

16. Hydrostatic Debridement
Using a high power hydrostatic debrider.
Usage of advancement technology such as versajet, ultrasonic
debridement machine to remove dead tissues.
Using high water jet pressure
Can either gently removed or excessively
removed.
May/may not exacerbate pain.

17. UAW is a lesser-known debridement method that uses low-frequency ultrasound waves.
There is evidence to show that the three clinical effects of atraumatic selective tissue debridement,
wound stimulatory effects, and antibacterial activity facilitate early healing of wounds, reducing the
cost to the healthcare system and improving the patient’s quality of life
effective removal of devitalized tissue
preservation of healthy tissue
creation of a clean, viable wound bed
disrupting of biofilms
prevention of biofilm reformation
Ultrasonic Assisted Debridement (UAW)

18. The ultrasonic vibrations of the UAW instrument generate
cavitation bubbles in the irrigation solution.
Those bubbles implode due to pressure changes and
generate strong sonic shock waves, so-called microjets.
Devitalized tissue and foreign bodies are removed from
the wound bed and biofilms are disrupted.
Healthy tissue is hardly affected due to its higher elastin
content, so that the healing process can proceed rapidly.

19. Combination Debridement
Combination
debridement
Mechanical
debridement
Autolytic
debridement
Enzymatic
debridement
Surgical
debridement
Hydrostatic
debridement
UAW