Debridement Methods

Debridement

Why debride?
Moist necrotic tissue provides a medium for infection, initiates an inflammatory response, places
a phagocytic demand on the wound, and retards healing. The presence of avascular tissue in the
wound promotes the growth of bacteria and tenacious biofilms, making topcial and systemic
antibiotics of limited value. Debridement may be selective or non-selective.
Debridement is the removal of dead or contaminated tissue and foreign material from a healable
wound (Sibbald et al., 2001; Ramundo and Walls, 2000). Healability must be determined prior to
debridement.

Debridement is a key component in wound healing. It facilitates the removal of all foreign
debris within a wound, thereby promoting the formation of granulation tissue and allowing
for definitive wound closure.

Debridement methods include surgical, enzymatic, autolytic, sharp, and mechanical methods
(Cervo et al., 2000). In VIHA, biological debridement is also available through the Foot and
Leg Ulcer Clinic (Victoria South Island).

It may be appropriate to use more than one debridement method (Sibbald et al., 2000).

Health care professionals who carry out sharp debridement must have completed the
appropriate special education as determined by VIHA, and they must also have the approval
of VIHA to perform the procedure.

Sharp, surgical debridement is contraindicated for a patient receiving anticoagulant therapy.

Autolytic debridement is contraindicated in the treatment of infected pressure ulcers (Cervo et

al., 2000).

Where there is no drainage or there is boggy surrounding tissue, leave the hard, dry eschar intact
on the lower legs, feet, or heels of those whose healing potential is compromised by inadequate
circulation. It provides a protective base for the wound (Maklebust & Sieggreen, 2001; Doughty,
Waldrop and Ramundo, 2000).

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Key Factors in Selecting Debridement Method

Surgical

Sharp

Enzymatic

Autolytic

Mechanical

Biologic

(by Physician)

(by Clinician)

Speed

Tissue
Selectivity

Painful
Wound

Exudate

Infection

Cost

1 indicates the most desirable method; 6 indicates the least desirable method.

(Adapted from Sibbald et al., 2000).

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Six Debridement Methods

(Krasner, D., et al., 2001; Sibbald, G., et al, 2001).

1. Surgical Method

Wound debris cut away by surgeon.

Usually requires operating room time.

Best used in large areas of necrosis and extremely contaminated wounds.

Also used to prepare wounds for grafting or skin flaps.

Not recommended for malignant wounds (Sibbald et al., 2000).

Fastest and most effective way to clean up a wound.

Good choice for diabetics with foot ulcers.

2. Enzymatic Method

Involves using enzymatic agents to breakdown necrotic debris.

Used on wounds prone to eschar formation and friction-type injuries.

Fast-acting and causes minimal damage to healthy tissue.

Requires prescription.

Good choice for home care patients who find it difficult to mobilize in order to go
to a clinic.

3. Autolytic Method

Do not use this method in the treatment of infected pressure ulcers (Cervo et al,
2000).

Uses bodys own enzymes to soften and breakdown the eschar.

Painless form of debridement.

Good choice for patients with low pain tolerance.

Slow method.

Requires close monitoring for infection.

Can be achieved with semi-occlusive or occlusive dressings or with the addition

of water-based gel to wound bed.

Used for Stage 3 ulcers, venous ulcers, and traumatic ulcers with light eschar.

Do not use on heavily exudating wounds.

If tissue autolysis is not apparent in 24 to 72 hours, use another form of debridement

(Sibbald, R.G., Williamson, D., Orsted, H., Campbell, K., Keast, D., Krasner, D., Sibbald, D.,
2000).

4. Sharp Method
Similar to the surgical method in terms of employing a sharp instrument to remove
non-viable tissue, but should not reach blood. Sharp debridement may be performed at the
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bedside by trained clinical staff (other than physician) and is less invasive than the surgical
method (Krasner, D. et al, 2001). While the Nurses (Registered) and Nurse Practitioners
Regulation (2005) states that RNs can perform wound care without an order, it further states
that RNs must complete additional education (not specified by CRNBC) before carrying out
sharps debridement down to healthy tissue.
5. Mechanical Method
Physical removal of debris from a wound.

May be used in the management of surgical wounds and pressure, ischemic, and
venous leg ulcers.

Simplest form is wet-to-dry but this technique is time-intensive and costly, and often
causes bleeding and pain, with removal leading to wound trauma.
Other methods include irrigation, pulsatile lavage, and whirlpool therapy.

Wound irrigation can be used to remove exudate at a force (4-15 psi) that will remove
the exudate but not damage new tissue (Rolstad, Ovington & Harris, 2000). A 30-35cc
syringe with an 18 or 19-gauge device) will deliver the correct PSI for removing exudate.
There are also commercial products that will provide the appropriate pressure.

Remember to indicate the date and time the normal saline bottle was opened because
normal saline will grow bacteria after 24 hours.

6. Maggot Debridement (Bio-Debridement, Live Debridement)

Maggots ingest necrotic tissue.

They are the larvae of a species of fly (calliphorids: Lucilia sericata; also known as
Pheaenicia sericata or greenbottle blowfly).
They are obtained from the University of California (Irving).

An import permit is required and special instructions must be followed to maintain

viable larvae (contact the Foot and Leg Ulcer Clinic at 250-519-1513).

Maggot debridement requires soft necrotic tissue.

The benefits to wound healing include:

selective debridement of dead tissue, cellular debris, and serous drainage

digestion of liquefied tissue

antimicrobial activity of maggot secretionsingestion of MRSA

growth-promoting maggot secretions

A special dressing is required to confine larvae. It must be changed every 48 hours to

evaluate progress. A decision is then made to either provide new larvae or discontinue
the treatment (when the wound bed is clean).
Double-bag and dispose of the dressing and larvae as biological waste.
Patients must be psychologically prepared to experience this therapy. However, there
is rarely any pain associated with maggot debridement (Sherman, R.A., 2000).
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