Debridement Health Article

Diagnosis/Preparation

The physician or nurse will begin by assessing the need for debridement. The wound will be examined, frequently by inserting a gloved finger into the wound to estimate the depth of dead tissue and evaluate whether it lies close to other organs, bone, or important body features. The assessment addresses the following points:

• the nature of the necrotic or ischaemic tissue and the best debridement procedure to follow
• the risk of spreading infection and the use of antibiotics
• the presence of underlying medical conditions causing the wound
• the extent of ischaemia in the wound tissues
• the location of the wound in the body
• the type of pain management to be used during the procedure

Before surgical or mechanical debridement, the area may be flushed with a saline solution, and an antalgic cream or injection may be applied. If the antalgic cream is used, it is usually applied over the exposed area some 90 minutes before the procedure.

Aftercare

After surgical debridement, the wound is usually packed with a dry dressing for a day to control bleeding. Afterward, moist dressings are applied to promote wound healing. Moist dressings are also used after mechanical, chemical, and autolytic debridement. Many factors contribute to wound healing, which frequently can take considerable time. Debridement may need to be repeated.

Risks

It is possible that underlying tendons, blood vessels or other structures may be damaged during the examination of the wound and during surgical debridement. Surface bacteria may also be introduced deeper into the body, causing infection.

Normal results

Removal of dead tissue from pressure ulcers and other wounds speeds healing. Although these procedures cause some pain, they are generally well tolerated by patients and can be managed more aggressively. It is not uncommon to debride a wound again in a subsequent session.

Alternatives

Adjunctive therapies include electrotherapy and low laser irradiation. However, at present, insufficient research has been completed to recommend their general use.

Not all wounds need debridement. Sometimes it is better to leave a hardened crust of dead tissue (eschar), than to remove it and create an open wound, particularly if the crust is stable and the wound is not inflamed. Before performing debridement, the physician will take a medical history with attention to factors that might complicate healing, such as medications being taken and smoking. The physician will also note the cause of the wound and the ways it has been treated. Some ulcers and other wounds occur in places where blood flow is impaired, for example, the foot ulcers that can accompany diabetes mellitus. In such cases, the physician or nurse may decide not to debride the wound because blood flow may be insufficient for proper healing.

BOOKS

Falanga, V., and K. G. Harding, eds. The Clinical Relevance of Wound Bed Preparation. New York: Springer Verlag, 2002.

Harper, Michael S. Debridement. Berkeley, CA: Paradigm Press, 2001.

Maklebust, JoAnn and Mary Y. Sieggreen. Pressure Ulcers: Guidelines for Prevention and Nursing Management. 2nd ed. Springhouse, PA: Springhouse Corporation, 1996.

PERIODICALS

Dervin, G. F., I. G. Stiell, K. Rody, and J. Grabowski. "Effect of Arthroscopic Debridement for Osteoarthritis of the Knee on Health-Related Quality of Life." The Journal of Bone and Joint Surgery (American) 85-A (January 2003): 10–19.

Friberg, T. R., M. Ohji, J. J. Scherer, and Y. Tano. "Frequency of Epithelial Debridement During Diabetic Vitrectomy." American Journal of Ophthalmology 135 (April 2003): 553–554.

Reynolds, N., N. Cawrse, T. Burge, and J. Kenealy. "Debridement of a Mixed Partial and Full Thickness Burn With an Erbium: YAG Laser." Burns 29 (March 2003): 183–188.

Schirmer, B. D., A. D. Miller, and M. S. Miller. "Single Operative Debridement for Pancreatic Abscess." Journal of Gastrointestinal Surgery 7 (February 2003): 289.

Terzi, C., A. Bacakoglu, T. Unek, and M. H. Ozkan. "Chemical Necrotizing Fasciitis Due to Household Insecticide Injection: Is Immediate Radical Surgical Debridement Necessary?" Human & Experimental Toxicology 21 (December 2002): 687–690.

Wolff, H., and C. Hansson. "Larval Therapy—an Effective Method of Ulcer Debridement." Clinical and Experimental Dermatology 28 (March 2003): 134–137.

ORGANIZATIONS

American Academy of Wound Management. 1255 23rd St., NW, Washington, DC 20037. (202) 521-0368. <http://www.aawm.org>.

Wound Care Institute. 1100 N.E. 163rd Street, Suite #101, North Miami Beach, FL 33162. (305) 919-9192. <http://woundcare.org>.

OTHER

Moses, Scott. "Wound Debridement." Family Practice Notebook. February 12, 2003 [cited May 15, 2003]. <http://www.fpnotebook.com/SUR12.htm>.

"Types of Wound Debridement." Wound Care Information Network: Types of Wound Debridement. 2002 [cited May 15, 2003]. <http://www.medicaledu.com/debridhp.htm>.

Richard H. Camer Monique Laberge, Ph.D.