Debridement is the removal of necrotic, dead tissue from the wound bed. It also plays a vital role in the tissue management concept of Wound Bed Preparation. Wound Bed Preparation is the comprehensive approach we use to get our chronic wounds to heal. There are two main categories of debridement: selective and non- selective debridement. Selective debridement are methods where only necrotic, non-viable tissue is removed from the wound bed. Non-selective debridement methods remove both necrotic tissue and viable living tissue.
There are 5 major debridement methods. They are known by the acronym BEAMS. The Selective methods include: Biological, Enzymatic and Autolytic debridement methods. The non-selective methods are: Mechanical and Sharp debridement methods.
Biological debridement is also known as maggot debridement 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 is 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. It is a faster method than autolytic debridement, but slower than sharp debridement.
Autolytic Debridement is the slowest type of debridement. It 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 is a method that uses an external force to separate the necrotic tissue from the wound bed. This may be painful and 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.
The fastest method of debridement is Sharp debridement. There are 2 types, 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.
The debridement method used will be chosen on a variety of factors including the wound characteristics, amount of necrotic tissue in wound, efficiency and selectivity of the debridement method itself, pain management for your patient, the cost of the procedure, exudate levels of the wound, presence of or risk of infection, the patients care setting, and the patients overall medical condition all need to be taken into account.
It is also important to remember 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 method for your patient.
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