Debridement is the removal of dead (necrotic) or infected skin tissue to help a wound heal. It’s also done to remove foreign material from tissue.
The procedure is essential for wounds that aren’t getting better. Usually, these wounds are trapped in the first stage of healing. When bad tissue is removed, the wound can restart the healing process.
Wound debridement can:
- help healthy tissue grow
- minimize scarring
- reduce complications of infections
Debridement isn’t required for all wounds.
Typically, it’s used for old wounds that aren’t healing properly. It’s also used for chronic wounds that are infected and getting worse.
Debridement is also necessary if you’re at risk for developing problems from wound infections.
In some cases, new and severe wounds may need debridement.
The best type of debridement depends on your:
- overall health
- risk for complications
Usually, your wound will require a combination of the following methods.
Biological debridement uses sterile maggots from the species Lucilia sericata, the common green bottle fly. The process is also called larval therapy, maggot debridement therapy, and biosurgery.
The maggots help wound healing by eating old tissue. They also control infection by releasing antibacterial substances and eating harmful bacteria.
The maggots are placed on the wound or in a mesh bag, which is kept in place with dressing. They’re left for 24 to 72 hours and replaced twice a week.
Biological debridement is best for wounds that are large or infected by antibiotic-resistant strains of bacteria, like MRSA. It’s also used if you can’t have surgery due to medical conditions.
Enzymatic debridement, or chemical debridement, uses an ointment or gel with enzymes that soften unhealthy tissue. The enzymes may come from an animal, plant, or bacteria.
The medication is applied once or twice a day. The wound is covered with a dressing, which is changed regularly. The dressing will take away dead tissue when it’s removed.
Enzymatic debridement is ideal if you have bleeding problems or a high risk for surgery complications.
It’s not recommended for large and severely infected wounds.
Autolytic debridement uses your body’s enzymes and natural fluids to soften bad tissue. This is done with a moisture-retaining dressing that’s typically changed once a day.
When moisture accumulates, old tissue swells up and separates from the wound.
Autolytic debridement is best for noninfected wounds and pressure sores.
If you have an infected wound that’s being treated, you can get autolytic debridement with another form of debridement.
Mechanical debridement is the most common type of wound debridement. It removes unhealthy tissue with a moving force.
Types of mechanical debridement include:
- Hydrotherapy. This method uses running water to wash away old tissue. It might involve a whirlpool bath, shower treatment, or syringe and catheter tube.
- Wet-to-dry dressing. Wet gauze is applied to the wound. After it dries and sticks to the wound, it’s physically removed, which takes away dead tissue.
- Monofilament debridement pads. A soft polyester pad is gently brushed across the wound. This removes bad tissue and wound debris.
Mechanical debridement is appropriate for noninfected and infected wounds.
Conservative sharp and surgical sharp debridement
Sharp debridement removes unhealthy tissue by cutting it off.
Conservative sharp debridement uses scalpels, curettes, or scissors. The cut doesn’t extend to surrounding healthy tissue. As a minor bedside surgery, it can be performed by a family physician, nurse, dermatologist, or podiatrist.
Surgical sharp debridement uses surgical instruments. The cut might include healthy tissue around the wound. It’s done by a surgeon and requires anesthesia.
Usually, sharp debridement isn’t the first choice. It’s often done if another method of debridement doesn’t work or if you need urgent treatment.
Surgical sharp debridement is also used for large, deep, or very painful wounds.
The procedure is useful if you haven’t had a dental cleaning for several years.
Unlike wound debridement, dental debridement doesn’t remove any tissue.
Before getting a wound debridement, preparation depends on your:
- health conditions
- type of debridement
Preparation may include:
- physical exam
- measurement of wound
- pain medication (mechanical debridement)
- local or general anesthesia (sharp debridement)
If you’re getting general anesthesia, you’ll need to arrange a ride home. You’ll also have to fast for a certain amount of time before your procedure.
Nonsurgical debridement is done in a doctor’s office or patient’s room. A medical professional will apply the treatment, which is repeated for two to six weeks or longer.
Sharp debridement is quick. During the procedure, the surgeon uses metal instruments to examine the wound. The surgeon cuts out old tissue and washes the wound. If you’re getting a skin graft, the surgeon will put it in place.
Often, debridement is repeated until the wound heals. Depending on your wound, your next procedure might be a different method.
Is debridement painful?
Biological, enzymatic, and autolytic debridement usually cause little pain, if any.
Mechanical and sharp debridement can be painful.
If you’re getting mechanical debridement, you may receive pain medication.
If you’re getting sharp debridement, you’ll get local or general anesthesia. Local anesthesia will numb the wound. General anesthesia will make you fall asleep, so you won’t feel anything.
Sometimes it can hurt when the dressing is changed. Ask your doctor about pain medication and other ways to manage pain.
It’s important to take care of your wound. This will help it heal and minimize the risk for complications.
Here’s what you can do to protect your wound during the healing process:
- Regularly change the dressing. Change it daily or according to your doctor’s instructions.
- Keep the dressing dry. Avoid swimming pools, baths, and hot tubs. Ask your doctor when you can shower.
- Keep the wound clean. Always wash your hands before and after you touch your wound.
- Don’t apply pressure. Use special cushions to avoid placing weight on your wound. If your wound is on your leg or foot, you might need crutches.
Your doctor will provide specific instructions on how to take care of your wound.
Generally, recovery takes 6 to 12 weeks.
Complete recovery depends on the severity, size, and location of the wound. It also depends on the debridement method.
Your doctor will determine when you can go back to work. If your job is physically demanding or involves the affected area, be sure to tell your doctor.
Proper wound care is essential for a smooth recovery. You should also:
- Eat healthy. Your body needs enough nutrients to heal.
- Avoid smoking. Smoking makes it difficult for nutrients and oxygens to reach your wound. This slows down healing. Smoking can be difficult, but a doctor can help you create a quit smoking plan right for you.
- Go to follow-up appointments. Your doctor needs to check your wound and make sure it’s healing properly.
Like all medical procedures, debridement poses a risk for complications.
Despite these possible side effects, the benefits often outweigh the risks. Many wounds can’t heal without debridement.
Pay attention to your wound. If you suspect an infection, contact your doctor.
Signs of infection include:
If you received general anesthesia, seek medical help if you have:
If your wound isn’t getting better, you might need debridement. The procedure helps wounds heal by removing dead or infected tissue.
Debridement can be done with live maggots, special dressings, or ointments that soften tissue. The old tissue can also be cut off or removed with a mechanical force, like running water.
The best type of debridement depends on your wound. Often multiple methods are used together.
Recovery takes 6 to 12 weeks. Practicing good wound care will help your wound heal properly. Call your doctor if you have increasing pain, swelling, or other new symptoms during recovery.