For wound healing to be effective, it’s crucial to remove all devitalized tissue (slough and eschar) for granulation tissue to fill the wound bed. This will also allow the epithelial tissue to move across the wound surface for it to eventually close.
This is why it’s important to understand what debridement is and how it impacts the entire wound healing process.
When do you debride?
There are basically two major signs you need to look out for to answer this question.
When wound healing becomes stagnant and there seems to be no progress despite constant treatment, it’s probably time to debride. Give the wound two weeks to heal. If the status doesn’t change within that span, debridement may be necessary.
The presence of slough and/or eschar is also an indication that wound healing may be necessary. The reason for this is that devitalized tissue can hinder the re-epithelialization process. It also enables bacterial growth and may prohibit proper tissue damage assessment beneath the surface of the wound.
Types of Debridement
Autolytic debridement
Autolytic debridement is a type of debridement that uses the body’s own enzymes and moisture to break down devitalized tissue. This type of debridement does not affect the surrounding tissue, is not painful, and is able to preserve cells. The only downside to this debridement type is that the process can be slow and it can be susceptible to bacterial growth.
Chemical debridement
Chemical debridement is a debridement type that stimulates healing by making the body think that a new wound has been created. Some of the advantages of this method are that it heals faster than autolytic while being more cost-effective as well. It can be painful though and may damage healthy tissues. Prolonged or excessive use of this method is also not recommended.
Enzymatic debridement
Enzymatic debridement is a debridement method that uses a chemical agent to break down devitalized tissue through enzymes. This method heals faster than the autolytic method but is a bit more expensive. It also requires a secondary dressing and cannot be used with silver dressings. It is also not antimicrobial.
Mechanical debridement
Mechanical debridement involves the use of wet to dry hydrotherapy or pulse lavage. As effective as this method is for a number of wounds such as venous stasis where cleaning the surrounding tissue may be required, this debridement type is not recommended because it’s painful but also because it can cause excessive bleeding.
Sharp debridement
This debridement method requires the use of sharp instruments such as a scalpel, curette, or laser to remove devitalized tissue. This method is considered the fastest way to remove slough and eschar while also allowing good control of tissue removed. The only disadvantage of this method is that it can be painful and can cause bleeding in patients on anticoagulants.
Final Thoughts
Knowing when to debride and which debridement type is suitable for the wound can go a long way in ensuring a fast and effective wound healing process. The debridement types provided should give you a good idea of which to use depending on the type of wound you’re looking to treat.
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