Wound Debridement - Types, Benefits, and Complications

Creator: Dr. Lakshika Sree. K. V.
Published: 2022-12-29T15:33:44

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Any wound in the body is treated by removing the infected or dead tissues from it through a process called wound debridement. Read the article to know more.

Written by

Dr. Lakshika Sree. K. V.

Medically reviewed by

Dr. Pandian. P

December 29, 2022

May 31, 2023

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Contents

Why Is Wound Debridement Done?
What Are the Types of Wound Debridement?
What Are the Benefits of Wound Debridement?
What Are the Complications of Wound Debridement?

Introduction

Wound debridement helps to clean the wound and promote healing. The wound is generally made free from nonviable tissues, infectious material, and moisture to provide an environment for vital tissues to grow.

Debridement is an important step in the healing of the wound. It is considered to play a fundamental role in wound management. Many different types of debridement are available that have their own advantages and disadvantages. Minor wounds usually heal on their own using the body’s immune reaction. The large wounds that are infectious have an increased amount of dead tissue. In such a situation, the body’s immune system alone is not enough and needs additional assistance by wound debridement. It is most helpful in individuals with diabetic ulcers as their immune system is compromised.

Why Is Wound Debridement Done?

Wound debridement is done to:

Remove the necrotic tissue and clean away the infected material.
Reduce the multiplication of bacterial cells within the wound.
Collect samples from the tissue to examine them and start the treatment with appropriate antibiotics.
Clear the wound area to place any skin grafts if necessary.

What Are the Types of Wound Debridement?

There are five types of debridement. They are:

1. Autolytic Debridement

This type of debridement occurs naturally in the body and is one of the slowest processes.
Certain types of cells produced in the body called phagocytic cells (cells that engulf the bacteria and kill them) and proteolytic enzymes (enzymes that break down the protein to decrease the inflammation), take part in this process.
A moist environment is needed for this process.
The body’s enzymes and the moist environment under the dressing enhance the necrotic (dead tissue) material in the wound to soften.
The softened dead tissue is then separated from the wound site.
The dressings used here are hydrocolloid, hydrogel, and transparent films.
Since it is a slow process, an alternate type of debridement is used if the wound is not healed in one or two days.

2. Biological Debridement:

This type is known as ‘larval therapy,’ where sterile larvae of Lucilia sericata (green bottle fly) are used to kill the bacteria in the wound. Maggots are another larva of a fly and serve the same purpose.
These larvae kill only the dead tissues and leave the vital tissues unaffected.
This type of debridement is helpful in large painful wounds.
It is not used in conditions such as abdominal wounds and wounds that are found near an area of septic arthritis (infection of a joint that has spread through the blood to another part of the body).

3. Enzymatic Debridement:

A proteolytic enzyme, collagenase, is used in this type.
Collagenase breaks down the collagen substance in the infected or dead tissues and removes them.
Dressings that retain moisture enhance the debridement.
This type is not recommended for large infected wounds.
It is expensive and can be used along with surgical debridement.

4. Mechanical Debridement:

Here, mechanical force is used in wound debridement.
This process removes both dead and vital tissues.
The mechanical force is delivered by wet-to-dry, pulsatile lavage, or wound irrigation.
In the wet-to-dry method, a moist dressing is placed on the wound. The healing takes place under a wet dressing and must be changed every four to six hours. The wound bed is not allowed to dry.
In the pulsatile lavage method, an electric device directs a stream of irrigating solution into the wound to clear away the debris.
The wound irrigation method delivers the fluid to the wound with gentle pressure. Too much pressure that spreads the fluid out of the wound area is avoided.
Hence, mechanical debridement is helpful in all types of wounds.

5. Surgical Debridement With Sharp Instruments:

The procedure is done under local anesthesia.
A well-trained surgeon performs the procedure.
A sharp instrument like a scalpel blade removes dead and infected tissues.
The skin around the wound is cleaned, and the depth of the wound is visualized by probing with a metal instrument.
The dead tissues are removed and washed away.
This method can also be combined with other types of debridement.
Complications might occur due to the debridement process, such as bleeding or allergic reactions to anesthesia.

The first four types are non-surgical methods, and the last type is a surgical procedure. The doctor decides which type of wound debridement to use for proper management. A combination of two methods is also considered for effective wound healing.

What Are the Benefits of Wound Debridement?

The following are the benefits of wound debridement:

Removing the dead tissue from the wound provides a good healing environment and space for the vital tissues to grow.
In diabetic patients with a foot ulcer, the debridement of the ulcer relieves the symptoms and reduces inflammation. This allows the patient to walk more comfortably.
The wound debridement process eliminates the bacteria that could provide pain and swelling.
Complications like amputation (loss) of any body part are avoided by early treatment with wound debridement.

What Are the Complications of Wound Debridement?

The possible complications that could occur with wound debridement include:

Allergic reactions to anesthesia.
Excessive bleeding from the wound site.
Persistence of pain even after debridement.
If the infection within the wound is not cleared completely, further growth of infectious bacteria occurs.
In some procedures like mechanical debridement, the vital and dead tissues are removed simultaneously due to excessive force.
The wound healing may get delayed.

The factors mentioned above are the problems that may arise after wound debridement. The factors that increase the risk of developing such problems are:

Obesity.
The habit of smoking in patients with a wound delays the healing process. Smoking reduces the blood supply, and oxygen does not reach the healing tissues. Due to inadequate blood and oxygen supply, bacteria multiply, and the healing process slows down. Hence, the patients must quit smoking.
The habit of alcohol consumption is also avoided.
Patients with immunocompromised conditions like diabetes are also at high risk of delayed healing and re-infection.

Conclusion

Wound healing and reducing infectious bacteria is the main goal of wound debridement. Different debridement methods are combined to enhance the healing process and provide a wound bed suitable for healthy tissues to grow. Complications may arise due to many reasons. The complications are avoided if the patient follows certain precautions to reduce the risk. The doctor must frame a proper management protocol for a good healing outcome.

Frequently Asked Questions

1. Is Debridement Considered a Surgical Procedure?

Depending on the extent of debridement required, it can be performed through various techniques. Some forms of debridement, such as surgical excision, may involve the use of surgical instruments and require anesthesia, making them as surgical procedures. However, other methods of debridement, such as enzymatic or autolytic debridement, do not involve surgery and can be performed without the need for anesthesia.

2. For Which Types of Wounds Is Debridement Necessary?

- Wounds that have not healed for a prolonged time, such as pressure ulcers, diabetic foot ulcers, or venous leg ulcers.
- Wounds that are infected or at a high risk of developing an infection.
- Wounds with a buildup of dead or necrotic tissue hinder the healing process.
- Wounds caused by accidents, injuries, or surgical procedures that have excessive tissue damage or foreign material present.
- Deep burns or burn wounds that require the removal of dead or damaged tissue.
- Post-operative wounds have developed complications, such as excessive scar tissue, poor healing, or infection.

3. What Is the Recommended Approach for Wound Debridement?

Wound debridement methods depend on the size, location, and type of wound. The common approaches are:
- Sharp Debridement: Using surgical instruments to physically remove dead tissue.
- Mechanical Debridement: Using techniques like wet-to-dry dressings, wound irrigation, or hydrotherapy to mechanically remove debris and dead tissue.
- Enzymatic Debridement: Applying topical enzymes to break down and remove necrotic tissue.
- Autolytic Debridement: Allowing the body's natural processes, such as moisture and enzymes, to gradually break down and remove dead tissue.
- Surgical Debridement: In more severe cases, surgical intervention may be necessary to remove extensive necrotic or infected tissue.

4. Which Type of Fluid Is Typically Utilized for Debridement?

The type of fluid used for debridement varies depending on the specific requirements of the wound such as the wound type and presence of infection and the debridement technique being employed. Common options include sterile saline solutions (0.9 percent sodium chloride), antiseptic solutions (Povidone-iodine or Chlorhexidine), enzymatic solutions (collagenase), and specialized wound cleansers.

5. Which Type of Dressing Is Used for Debridement?

The type of dressing used for debridement depends on the specific needs of the wound and the debridement technique used. Some common dressing options include non-adherent dressings, hydrogels, alginate dressings, foam dressings, and specialty debridement dressings. The choice of dressing is determined by factors such as wound characteristics, the presence of infection, moisture management, and the need for debridement.

6. What Is the Primary Choice for Wound Debridement?

The primary choice for wound debridement depends on various factors, such as the specific characteristics of the wound such as the condition of the wound bed, depth of the wound, health of the skin around the wound, presence of drainage, and vascularity and the individual's age and overall health condition.

7. Does Debridement Cause Pain?

Debridement can cause discomfort or pain depending on the individual and the specific technique used. The intensity of pain an individual may experience can vary from mild to moderate. Pain management measures such as the use of local anesthesia or topical analgesics may be used to numb the area before debridement and to ensure patient comfort.

8. Can Debridement Help the Healing Process?

Yes, debridement can help wounds heal better. It removes dead tissue and debris, creating a clean environment for healing. This promotes the growth of healthy tissue and reduces the risk of infection. Debridement also improves blood flow and encourages new blood vessel formation, which subsequently aids in the healing process.

9. What Is the Recovery Period Following Debridement?

The recovery period following debridement varies depending on factors such as the size and depth of the wound, the overall health of the individual, and the specific debridement technique used. Generally, after debridement, the wound enters the healing phase. Some individuals may require a recovery period of a few weeks, while others may require a more extended period.

10. What Is the Duration of the Debridement Procedure?

The duration of the debridement procedure can differ depending on various factors such as the size and complexity of the wound, the type of debridement being performed, and the patient's individual condition. Simple debridements for smaller wounds may be quick, while more extensive or complex debridements may take longer, ranging from 30 minutes to over an hour.

11. Can One Perform Wound Debridement at Home?

Performing wound debridement at home is not advised. It requires expertise since it is a medical procedure and is done in a controlled and sterile environment to avoid complications. For home wound care, one may gently cleanse the wound using mild solutions and apply suitable dressings to cover the wound until one can get professional medical assistance.

12. Is Betadine Considered a Form of Debridement?

Betadine is not considered a form of debridement itself. Betadine, comprising Povidone-iodine as its active component, is a solution used for its antiseptic properties. It is commonly used for wound cleansing to help prevent infection. While Betadine can assist in creating a clean environment for wound healing, it does not perform the actual removal of non-viable tissue or debris that is characteristic of the debridement procedure.

13. What Is the Use of Debridement Ointment?

Debridement ointment is a type of cream or gel that helps remove dead tissue, debris, and foreign substances from wounds. It creates a clean environment for healing. Debridement ointments usually contain enzymes or chemicals that break down and remove unhealthy tissue. They are applied directly to the wound to promote the growth of healthy tissue.

14. What Is the Efficiency Rate of Debridement?

While debridement is generally considered an important aspect of wound care that promotes healing, a specific efficiency rate can vary in different cases. The effectiveness of debridement can vary depending on factors such as the type and extent of the wound, the chosen method of debridement, and the individual’s overall health condition. However, in most cases, debridement procedures are successful.

15. What Is the Cost of a Debridement Procedure?

The average cost for a debridement procedure ranges from approximately three hundred dollars to nine hundred dollars. The cost of a debridement procedure can differ depending on various factors, including the type of debridement performed, the healthcare provider or facility where the procedure is done, the location, and the specific circumstances of the patient's condition.

16. How to Clean a Deep Wound Efficiently?

- Wash hands thoroughly or use gloves for hygiene.
- Use sterile tweezers to remove debris from the wound.
- Rinse the wound with clean, running water.
- Use mild soap to clean the surrounding skin, avoiding the wound itself.
- Pat the wound dry gently with a clean, sterile gauze or cloth.
- Apply an appropriate wound dressing.
- Seek medical assistance at the earliest for appropriate care.

17. What Does Natural Debridement Refer To?

Natural debridement refers to the body's natural way of getting rid of dead or damaged tissue from a wound. When a wound heals, the body uses its own processes to break down and remove the unhealthy tissue. This can happen through different mechanisms like enzymes breaking down the dead tissue, immune cells engulfing and removing debris, or the formation of new tissue to replace the damaged areas.

Sources

Dr. Pandian. P

General Surgery

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