As a wound care nurse, one of the most frequent procedures you’ll be exposed to is that of debridement.
This is especially true if you work in a skills nursing facility or an adult care facility where some of the patients suffer from immobility leading to bedsores.
It’s essential to understand what debridement is, why the procedure is necessary, and its role in the wound healing process.
What is Debridement?
Debridement is the process of removing dead or necrotic tissue to allow wounds to heal. The procedure is also done to remove foreign material from the tissue.
Such a procedure is necessary especially for wounds that aren’t healing as expected, particularly if they have slough. Our goal is to restart the healing process after the necrotic tissue has been removed by debridement.
Apart from allowing wounds to heal better, debridement can also minimize scarring and reduce the risk of infection.
As effective as the procedure is, not all wounds require debridement. It’s usually carried out on chronic non-healing wounds that have slough though it’s also commonly done to acute wounds as well if necrotic tissue is noted.
Types of Debridement
Debridement is classified into several types depending on the nature and severity of the wound.
Autolytic debridement is the process of using the body’s enzymes and fluids to soften the dead tissue and is carried out using a moisture-retaining dressing that is ideally replaced daily. The old tissue is expected to separate from the wound as soon as moisture accumulates.
Biological debridement, on the other hand, is the process of using sterile maggots to aid in the wound healing process. What the maggots do is eat away the dead tissue and control the infection by releasing antibacterial substances.
Enzymatic debridement, also known as chemical debridement, is done through the use of an ointment or gel whose enzymes can help soften necrotic tissue. These chemicals may come either from animals, plants, bacteria.
Mechanical debridement is the most common of the debridement types and is further classified into three subtypes:
Hydrotherapy or the use of running water to remove dead tissue
Monofilament debridement pads or the removal of old tissue using a soft polyester pad
Wet-to-dry dressing or the use of a wet gauze to remove unwanted tissues
Surgical debridement, as the name implies, is the process of removing dead tissue via surgery. With this procedure, dead tissue is removed by surgically cutting it off.
What should you do before a debridement?
Typically, debridement requires a physical exam, wound measurement, pain medication, and local or general anesthesia if necessary.
Surgical debridements are often done inside a doctor’s office or a patient’s room in a nursing home.
The procedure may be repeated depending on how the wound responds. If the wound isn’t getting better as expected, another round of debridement may be necessary.
Not all debridement types are painful. Autolytic, biological, and enzymatic debridement usually causes very little discomfort.
Medical and sharp debridement are considered to be more painful thus requiring you oral pain medication as well as local anesthesia.
It’s important to note that proper wound care is essential for wounds that have undergone debridement to avoid infections and further complications.
It’s important to always keep the wound clean by regularly (daily) changing the dressing and keeping it dry. Always make sure to wash your hands thoroughly as well before touching the wound and avoid applying pressure on it as it heals.
Recovery time for debridements usually takes between 4-7 days depending on the location, severity, and size of the wound.
Wounds should naturally heal with proper wound care but if it’s not getting better at the pace you expected it to, then it’s probably best to see a doctor because the wound may require serial debridements to allow the healing process to proceed.