Wound Debridement

Aka: Wound Debridement, Skin Wound Debridement, Decubitus Ulcer Debridement, Sharp Debridement, Mechanical Debridement, Autolytic Debridement, Enzymatic Debridement, Chemical Debridement, Debridement

II. Contraindications

  1. Do not debride wounds that are poorly vascularized
    1. Evaluate first with Ankle-Brachial Index if suspect significant Peripheral Arterial Disease

III. Mechanism

  1. Wound Debridement is a cornerstone of Chronic Wound management
  2. Debridement removes tissue that delays healing
    1. Necrotic tissue or exudate
    2. Biofilm (Bacterial colonization)

IV. Indications

  1. Preserve granulation tissue (pink)
  2. Debride fibrin tissue (white, yellow, or green tissue)
  3. Debride hematomas
  4. Debride necrotic tissue (black wound)
    1. Full thickness burn (Third Degree Burn)
    2. Pressure Sore (Stages 3 or 4)
    3. Gangrenous ulcer
  5. Exceptions: Stable healing ulcer with dry eschar
    1. Dry eschar does not require Debridement
    2. Debridement indications
      1. Edema or erythema
      2. Fluctuance
      3. Discharge

V. Techniques: Sharp Debridement

  1. Scalpel or scissors to remove devitalized tissue
  2. Indications
    1. Removing adherent eschar
    2. Devitalized, necrotic tissue in extensive ulcer
    3. Urgent Debridement in advanced Cellulitis or Sepsis
  3. Anesthetic
    1. Topical Anesthetic (4% topical Lidocaine applied 5-10 min before Debridement)
    2. Deeper involvement will require local Anesthetic (e.g. Lidocaine 1% injection)
  4. Wound preparation
    1. Debridement is a clean, but not sterile procedure (wounds are already colonized)
    2. Irrigate wound with sterile saline or water to remove old product or drainage
    3. Hibiclens (or other antimicrobial soap) as a periwound wash for more contaminated wounds
    4. Dab wound bed and necrotic material after irrigation (eases Debridement)
  5. Sharp Debridement techniques
    1. Lift necrotic tissue and snip with scissors
      1. Indicated when clear plane between dead tissue and viable tissue
    2. Lift necrotic tissue and shave with scalpel (#15 blade)
      1. Lift tissue edge and apply shallow strokes horizontal to skin surface to tease away necrotic tissue
    3. Incise
      1. Entry into a hard eschar that has no obvious edge top approach for Debridement
    4. Cross Hatch
      1. Indicated to start debriding tightly adherent fibrous tissue
      2. Apply shallow strokes (<1 mm) perpendicular to surface in criss-cross pattern into the adherent material
      3. Allows for non-Sharp Debridement dressings (e.g. enzymatic agents) to penetrate for better activity
  6. Follow-up Sharp Debridement
    1. Apply clean, dry dressings for 8-24 hours
    2. Restart wet-to-moist (or wet-to-dry) dressings
  7. Debridement under Anesthesia Indications
    1. Indicated for extensive stage 4 Decubitus Ulcers
    2. Consider bone biopsy to assess for Osteomyelitis

VI. Techniques: Other Debridement techniques (via dressings)

  1. Mechanical Debridement
    1. Wet-to-Dry Dressing
    2. Hydrotherapy (Occlusive Wound Dressing)
      1. Transparent Film Dressing
    3. Wound irrigation
    4. Dextranomers
  2. Enzymatic Debridement (Chemical Debridement)
    1. Indicated where surgical Debridement is not possible and wound infected or dead tissue
    2. Papain-urea (e.g. Accuzyme, Panafil)
    3. Trypsin-balsam peru-Castor oil (e.g. Xenaderm)
    4. Collagenase (Santyl)
  3. Autolytic Debridement
    1. In vivo enzymes self-digest devitalized tissue
    2. Contraindicated for infected wounds
    3. Synthetic dressing applied to cover wound
      1. Mildly draining wounds: Hydrogel Dressing, Hydrocolloid Dressing
      2. Moderately to strongly draining wounds: Alginate Dressing

VII. References

  1. Cole (2017) Wound Care Update, Park Nicollet Conference, St Louis Park, MN (attended 9/15/2017)

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Related Studies

Ontology: Debridement (C0011079)

Definition (CHV) surgical removal of foreign material and dead tissue from a wound in order to prevent infection and promote healing
Definition (CHV) surgical removal of foreign material and dead tissue from a wound in order to prevent infection and promote healing
Definition (SCTSPA) Remoción de tejido necrótico
Definition (MSHCZE) chirurgické vyčištění rány, součást toalety rány. Spočívá v odstranění nekrotických částí a tkání, které nemají šanci na zhojení (devitalizovaných, s porušeným krevním zásobením aj.). Nověji se někdy k d. užívají i enzymy, které odstraňují fibrin a nekrotické tkáně. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (SNOMEDCT_US) Removal of devitalized tissue
Definition (NCI) A procedure to remove dead tissue or foreign material from a wound to expose underlying healthy tissue and to promote healing.
Definition (MSH) The removal of foreign material and devitalized or contaminated tissue from or adjacent to a traumatic or infected lesion until surrounding healthy tissue is exposed. (Dorland, 27th ed)
Concepts Therapeutic or Preventive Procedure (T061)
MSH D003646
SnomedCT 36777000, 129317004
English Debridements, debridements, debridement, Debridement, Debridement - action, Debridement (procedure), Debridement - action (qualifier value), Debridement, NOS, Debridement NOS
Spanish desbridamiento - acción, Debridación, desbridamiento (acción), desbridamiento (procedimiento), desbridamiento - acción (calificador), desbridamiento, Desbridamiento
Swedish Rensning
Czech debridement, Debridement, débridement, nekrektomie
Finnish Haavan revisio
Russian RANY, KHIRURGICHESKAIA OBRABOTKA, РАНЫ, ХИРУРГИЧЕСКАЯ ОБРАБОТКА
Dutch débridement, Wondtoilet
Japanese ﾃﾞﾌﾞﾘｰﾄﾞﾏﾝ, デブリードマン
Polish Chirurgiczne opracowanie rany, Opracowanie rany chirurgiczne
Hungarian Debridement
Norwegian Debridering, Sårrensing
French Débridement
German Wundtoilette
Italian Sbrigliamento
Portuguese Desbridamento
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Debridement of wound of skin (C0191342)

Definition (NCI) A procedure to remove dead tissue or foreign material from a skin wound to expose underlying healthy tissue and to promote healing.
Concepts Therapeutic or Preventive Procedure (T061)
SnomedCT 85875009
English Debridement of Wound of Skin, debridement of wound (treatment), skin debridement (treatment), wound care debridement, debridement of wound, skin debridement, wound debridement, debridement skin, Debridement;wound, debridement wounds, debridement wound, Debridement of wound of skin, Surgical toilet of skin wound, Debridement of skin, Wound debridement, Debridement of wound of skin (procedure)
Spanish Desbridamiento de herida, desbridamiento de herida en la piel, desbridamiento de herida cutánea, toilet quirúrgica de herida en la piel, toilet quirúrgica de una herida en la piel, desbridamiento de una herida en la piel, desbridamiento de una herida en la piel (procedimiento), desbridamiento de herida en la piel (procedimiento)
Italian Sbrigliamento di ferita
French Débridement d'une plaie
Dutch wonddébridement
German Wunddebridement
Portuguese Debridamento de ferida
Japanese ｿｳｴﾝｾﾂｼﾞｮ, 創縁切除
Czech Debridement rány
Hungarian Seb necrectomia
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: chemical debridement of wound (C2045774)

Concepts Therapeutic or Preventive Procedure (T061)
English wound debridement chemical, chemical debridement of wound (treatment), chemical debridement of wound
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: mechanical debridement of wound (C2203338)

Concepts Therapeutic or Preventive Procedure (T061)
English mechanical debridement of wound (treatment), mechanical debridement of wound
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: sharp debridement of wound (C2203344)

Concepts Therapeutic or Preventive Procedure (T061)
English sharp debridement of wound (treatment), sharp debridement of wound
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: autolytic wound debridement (C2236099)

Concepts Therapeutic or Preventive Procedure (T061)
English autolytic wound debridement (treatment), wound debridement autolytic, autolytic wound debridement, autolytic debridement of wound
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Procedure

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