Caring for a wound can be complicated. Once the bleeding and pain are under control, you and your doctor need to make sure that the injury can heal and that it doesn’t get infected. Sometimes, the healing process can leave some tissue so damaged that it's no longer viable.
When Is Debridement Useful?
If you have a significant wound that leads to tissue death, or gangrene, your doctor may need to remove the damaged tissue. Dead tissue can harbor bacteria that may cause more extensive infections. Removing the nonviable tissue promotes healing and reduces the risk of further complications. The process of removing nonviable tissue is called debridement.
Debridement is only necessary when a wound isn’t healing well on its own. In most cases, your own healing process will kick in and begin repairing injured tissues. If there is any tissue that dies, your naturally-occurring enzymes will dissolve it, or the skin will slough off.
You should only need debridement if you have a serious or chronic wound that doesn’t respond to your immune system. Injuries such as diabetic leg ulcers or severe burns may require debridement. You may need debridement to clear out any debris that has entered a wound. Your doctor can tell you if you need a debridement procedure to help heal a wound.
Types of Debridement
There are multiple ways to debride a wound. Your doctor will decide which one is best based on your health and the severity of your wound.
Surgical debridement. Doctors can cut away nonviable tissue with a scalpel or other sharp medical tools. During the procedure, you may be under anesthesia so that you won’t feel pain. Doctors will carefully examine the wound to locate all nonviable tissue. They can then remove it but leave viable tissue intact.
Autolytic debridement. Your body is capable of clearing out nonviable tissue from a wound under certain circumstances. You produce enzymes that can liquefy dead tissue and leave healthy tissue intact. To facilitate the process, your doctor will apply special dressings such as hydrogel coverings to prevent infection while your body clears out the wound. The option is best for small wounds that are not infected. It can take several days for the process to be complete.
Enzymatic debridement. Your doctor may decide to apply a synthetic enzyme to your wound. A variety of chemicals such as clostridium, histolyticum, collagenase, varidase, papain, and bromelain are effective at dissolving nonviable tissue on a wound. These treatments can also affect viable skin, so doctors may be cautious about recommending this method of debridement.
Mechanical debridement. There are several ways to clean out a wound using a physical or mechanical process. Doctors can use hydrotherapy or hydrosurgical debridement to clean your wound using a stream of sterile saline. The saline solution clears both nonviable tissue and bacteria from the wound. Another mechanical debridement technique is wet-to-dry dressings. Doctors apply a moist sterile bandage to your wound and allow it to dry. When the dried dressing is removed, it pulls away dead tissue that has adhered to it. This process is painful and runs a risk of removing healthy tissue as well.
Biological debridement. This is sometimes called “ maggot therapy” or “larval therapy.” Doctors can apply larvae of certain insect types to a wound. The larvae consume only dead tissue and leave viable tissue intact. The treatment is effective, but the psychological aversion to it may make it less desirable than other methods.
Risks Of Debridement
Debridement is generally a safe procedure, but there is always a risk of complications. Some possible risks from debridement include.
- Delayed healing
- Loss of healthy tissue
If you are having surgical debridement, you may need general anesthesia. After debridement, you might experience pain or discomfort. Your doctor will discuss the risks and how to manage pain with you.
It will be important to follow your doctor’s instructions about caring for your wound after a debridement procedure. Proper wound care will reduce your risk of infection. Call your doctor immediately if you have symptoms of infection such as:
- Fever and chills
- If the skin around the wound looks chalky white, blue, or black
- Pain that doesn’t get better when you take your medicine as directed
- Redness, swelling, new or increasing pain, excessive bleeding, or discharge around your wound
Wound care is complicated, so work with a doctor to make sure you get appropriate treatment. Not all wounds need debridement, but some benefit from the process. If you have a serious wound, your doctor can tell you if it needs debridement.