Wound Care and Debridement: Know the BEAMS

These five major debridement methods for wound clinicians are easy to remember (hint: BEAMS), and key to the wound healing process.

Wound Care and Debridement: Know the BEAMS

When it comes to healing chronic wounds, clinicians are all about Wound Bed Preparation, which is the process of removing local barriers to wound healing. A key to this process is debridement – the removal of necrotic, dead tissues from the wound bed.

In order to provide the best care possible for your patients, it’s important to know the differences between the two main categories and five major methods of debridement.

Debridement Categories

Debridement methods can be categorized under two main types:

  • Selective debridement – methods where only necrotic, non-viable tissue is removed from the wound bed.
  • Non-selective debridement – methods that remove both necrotic tissue and viable living tissue.

There are five major debridement methods that make up these two debridement categories, which can easily be remembered by the acronym BEAMS:

  • Selective methods – Biological, Enzymatic and Autolytic
  • Non-selective methods – Mechanical and Sharp

 

Debridement Flashcards

Five Major Debridement Methods (BEAMS)

Biological Debridement

Also known as maggot debridement, biological debridement includes using sterile medical maggots to remove necrotic tissue. These sterile maggots debride necrotic tissue by liquefying and digesting it. They also kill and ingest bacteria while stimulating wound healing.

Enzymatic Debridement

This method includes the use of collagenase ointment (Santyl) once daily to the wound bed. The ointment works from the bottom up to loosen the collagen that holds the necrotic material to the wound bed. Enzymatic debridement is faster than autolytic debridement, but slower than sharp debridement.

Autolytic Debridement

Autolytic debridement is the slowest type of debridement, and uses the body’s own enzymes to assist in breaking down the necrotic tissue. This is achieved by using products that maintain a moist wound environment. This type of debridement is not appropriate for large amounts of necrotic tissue or infected wounds.

Mechanical Debridement

This method uses an external force to separate the necrotic tissue from the wound bed. It may be painful, as it removes non-viable as well as viable tissue.  Methods include wet to dry dressings, scrubbing, whirlpool and irrigation. Contraindications for mechanical debridement would be epithelializing and granulating wounds.

Sharp Debridement

Sharp Debridement session at Wild On Wounds 2016

HOW TO: HANDS ON Sharp Debridement session at Wild On Wounds 2016

The fastest method of debridement is sharp debridement. There are two different types in this category: Sharp surgical (done by a surgeon, physician or podiatrist) or sharp conservative (done at bedside by a trained clinician). It involves the use of scalpels,scissors, curettes or forceps.  Sharp surgical is a major procedure that sacrifices some viable tissue, where sharp conservative is a minor procedure done at the bedside that removes non-viable tissue.

Which debridement method is best?

The debridement method you choose for treatment will be based on a variety of factors, all of which need to be considered. These include:

  • wound characteristics
  • amount of necrotic tissue in wound
  • efficiency and selectivity of the debridement method itself
  • pain management for the patient
  • procedure cost
  • exudate levels of the wound
  • presence or risk of infection
  • patient care setting
  • patients overall medical condition

It is also important to remember that not every patient with necrotic tissue will always be a candidate for debridement. Be sure that you understand indications and contraindications for each debridement method when you are selecting the appropriate one for your patient.

Are you on board with debridement?

As you know, debridement is an important part of Wound Bed Preparation, and using the right method can assist in getting those chronic wounds on the path to healing. So we’re curious: which methods are you the most familiar with, and have you had any particularly challenging experiences when using them? Which method(s) are used the most within your facility? Please tell us your stories and share your comments below.

Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and OstomyManagement. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.

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