According to the National Library of Medicine, wound debridement, or the removal of nonviable tissue, biofilm, and bioburden from the wound bed, is an essential part of standard wound treatment.

Bioburden consists of microorganisms on the surface of the wound bed, while biofilm is a substance created by the presence of bacteria, microbes, and cellular debris. The removal of these tissues optimizes the wound bed for ongoing granulation of healthy tissue and promotes epithelialization.

Tissues like these act as barriers to wound healing, and chronic wounds will be unable to heal if these tissues are present — making debridement an essential part of the healing process.

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What is Debridement?

Wound 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. Selective methods are when only necrotic, non-viable tissue is removed from the wound bed. Non-selective methods remove both necrotic tissue and viable living tissue.

The 5 Major Debridement Methods

These five major debridement methods for wound clinicians are easy to remember (BEAMS), and key to the wound healing process. Debridement methods can be categorized under two main types.

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I have been training wound care clinicians in sharp debridement for more than 16 years, yet questions and confusion still abound about this practice.

Many clinicians have either received no education or incorrect education regarding sharp debridement and its use in wound care. 

This often leads to infrequent use of sharp debridement or worse, the inappropriate use of the practice. This is a skilled procedure and one should be properly trained before engaging in it.

My hope is to cut through the confusion and offer a solid explanation of this highly effective treatment for managing wounds.

Plaintiffs often express shock and disbelief after eschar is removed, which often leaves a wound larger than the original size of the eschar.

Wound photo: “Stage 4 decubitus displaying the Gluteus medius muscle attached to the crest of the ilium” by Bobjgalindo is licensed under CC BY 2.0

“We were in shock and couldn’t believe our eyes. It was like half her foot was gone.”

“My husband and I were horrified when we saw what they did.”

“My sister and I looked at each other, and I just kept asking why?”

“I had to leave the room and go the bathroom to cry when I saw what they did to my mother.”

You might think these quotes are from people who have witnessed a shocking crime or some sort of violence, but they are not. These are quotes from family members, now plaintiffs, who are suing for poor medical care related to a chronic wound. Their shock all had one thing in common—it came after seeing a wound that was surgically debrided.

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The use of maggots in wound care is making a comeback – in the form of maggot debridement therapy – and wound clinicians can’t wait to talk about it.

Most people don’t get too excited about maggots. In fact, the mere mention of legless larvae surely triggers gag responses and/or skin crawling in millions of non-healthcare citizens everywhere. But that’s definitely not the case for those of us in wound care.

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