II. Contraindications
- Avoid Debridement of slough on the heels of the foot
- Do not debride wounds that are poorly vascularized or on ischemic limbs
- Evaluate first with Ankle-Brachial Index if suspect significant Peripheral Arterial Disease
III. Mechanism
- Wound Debridement is a cornerstone of Chronic Wound management
- Debridement removes tissue that delays healing
- Necrotic tissue or exudate
- Biofilm (Bacterial colonization)
IV. Indications
- Preserve granulation tissue (pink)
- Debride Fibrin tissue (white, yellow, or green tissue)
- Debride Hematomas
- Debride necrotic tissue (black wound)
- Full thickness burn (Third Degree Burn)
- Pressure Sore (Stages 3 or 4)
- Gangrenous ulcer
- Exceptions: Stable healing ulcer with dry eschar
- Dry eschar does not require Debridement
- Debridement indications
- Edema or erythema
- Fluctuance
- Discharge
V. Techniques: Sharp Debridement
- Scalpel or scissors to remove devitalized tissue
- Indications
- Removing adherent eschar
- Devitalized, necrotic tissue in extensive ulcer
- Urgent Debridement in advanced Cellulitis or Sepsis
-
Anesthetic
- Topical Anesthetic (4% topical Lidocaine applied 5-10 min before Debridement)
- Deeper involvement will require Local Anesthetic (e.g. Lidocaine 1% injection)
-
Wound preparation
- Debridement is a clean, but not sterile procedure (wounds are already colonized)
- Irrigate wound with sterile saline or water to remove old product or drainage
- Hibiclens (or other antimicrobial soap) as a periwound wash for more contaminated wounds
- Dab wound bed and necrotic material after irrigation (eases Debridement)
- Sharp Debridement techniques
- Lift necrotic tissue and snip with scissors
- Indicated when clear plane between dead tissue and viable tissue
- Lift necrotic tissue and shave with scalpel (#15 blade)
- Lift tissue edge and apply shallow strokes horizontal to skin surface to tease away necrotic tissue
- Incise
- Entry into a hard eschar that has no obvious edge top approach for Debridement
- Cross Hatch
- Indicated to start debriding tightly adherent fibrous tissue
- Apply shallow strokes (<1 mm) perpendicular to surface in criss-cross pattern into the adherent material
- Allows for non-Sharp Debridement dressings (e.g. enzymatic agents) to penetrate for better activity
- Lift necrotic tissue and snip with scissors
- Follow-up Sharp Debridement
- Apply clean, dry dressings for 8-24 hours
- Restart wet-to-moist (or wet-to-dry) dressings
- Debridement under Anesthesia Indications
- Indicated for extensive stage 4 Decubitus Ulcers
- Consider bone biopsy to assess for Osteomyelitis
VI. Techniques: Other Debridement techniques (via dressings)
- Mechanical Debridement
- Wet-to-Dry Dressing
- Hydrotherapy (Occlusive Wound Dressing)
- Wound Irrigation
- Dextranomers
- Enzymatic Debridement (Chemical Debridement)
- Indicated where surgical Debridement is not possible and wound infected or dead tissue
- Papain-urea (e.g. Accuzyme, Panafil)
- Trypsin-balsam peru-Castor Oil (e.g. Xenaderm)
- Collagenase (Santyl)
- Autolytic Debridement
- In vivo enzymes self-digest devitalized tissue
- Contraindicated for infected wounds
- Synthetic dressing applied to cover wound
- Mildly draining wounds: Hydrogel Dressing, Hydrocolloid Dressing
- Moderately to strongly draining wounds: Alginate Dressing
VII. References
- Cole (2017) Wound Care Update, Park Nicollet Conference, St Louis Park, MN (attended 9/15/2017)
Images: Related links to external sites (from Bing)
Related Studies
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 | デブリードマン, 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 |
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 | ソウエンセツジョ, 創縁切除 |
Czech | Debridement rány |
Hungarian | Seb necrectomia |
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 |
Ontology: mechanical debridement of wound (C2203338)
Concepts | Therapeutic or Preventive Procedure (T061) |
English | mechanical debridement of wound (treatment), mechanical debridement of wound |
Ontology: sharp debridement of wound (C2203344)
Concepts | Therapeutic or Preventive Procedure (T061) |
English | sharp debridement of wound (treatment), sharp debridement of wound |
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 |