Professional Documents
Culture Documents
Debridement
Why debride?
Moist necrotic tissue provides a medium for infection, initiates an inflammatory response, places
a phagocytic demand on the wound, and retards healing. The presence of avascular tissue in the
wound promotes the growth of bacteria and tenacious biofilms, making topcial and systemic
antibiotics of limited value. Debridement may be selective or non-selective.
Debridement is the removal of dead or contaminated tissue and foreign material from a healable
wound (Sibbald et al., 2001; Ramundo and Walls, 2000). Healability must be determined prior to
debridement.
Debridement is a key component in wound healing. It facilitates the removal of all foreign
debris within a wound, thereby promoting the formation of granulation tissue and allowing
for definitive wound closure.
Debridement methods include surgical, enzymatic, autolytic, sharp, and mechanical methods
(Cervo et al., 2000). In VIHA, biological debridement is also available through the Foot and
Leg Ulcer Clinic (Victoria South Island).
It may be appropriate to use more than one debridement method (Sibbald et al., 2000).
Health care professionals who carry out sharp debridement must have completed the
appropriate special education as determined by VIHA, and they must also have the approval
of VIHA to perform the procedure.
Where there is no drainage or there is boggy surrounding tissue, leave the hard, dry eschar intact
on the lower legs, feet, or heels of those whose healing potential is compromised by inadequate
circulation. It provides a protective base for the wound (Maklebust & Sieggreen, 2001; Doughty,
Waldrop and Ramundo, 2000).
-1-
Sharp
Enzymatic
Autolytic
Mechanical
Biologic
(by Physician)
(by Clinician)
Speed
Tissue
Selectivity
Painful
Wound
Exudate
Infection
Cost
1 indicates the most desirable method; 6 indicates the least desirable method.
-2-
1. Surgical Method
2. Enzymatic Method
Requires prescription.
Good choice for home care patients who find it difficult to mobilize in order to go
to a clinic.
3. Autolytic Method
Do not use this method in the treatment of infected pressure ulcers (Cervo et al,
2000).
Slow method.
Used for Stage 3 ulcers, venous ulcers, and traumatic ulcers with light eschar.
4. Sharp Method
Similar to the surgical method in terms of employing a sharp instrument to remove
non-viable tissue, but should not reach blood. Sharp debridement may be performed at the
-3-
bedside by trained clinical staff (other than physician) and is less invasive than the surgical
method (Krasner, D. et al, 2001). While the Nurses (Registered) and Nurse Practitioners
Regulation (2005) states that RNs can perform wound care without an order, it further states
that RNs must complete additional education (not specified by CRNBC) before carrying out
sharps debridement down to healthy tissue.
5. Mechanical Method
Physical removal of debris from a wound.
May be used in the management of surgical wounds and pressure, ischemic, and
venous leg ulcers.
Simplest form is wet-to-dry but this technique is time-intensive and costly, and often
causes bleeding and pain, with removal leading to wound trauma.
Other methods include irrigation, pulsatile lavage, and whirlpool therapy.
Wound irrigation can be used to remove exudate at a force (4-15 psi) that will remove
the exudate but not damage new tissue (Rolstad, Ovington & Harris, 2000). A 30-35cc
syringe with an 18 or 19-gauge device) will deliver the correct PSI for removing exudate.
There are also commercial products that will provide the appropriate pressure.
Remember to indicate the date and time the normal saline bottle was opened because
normal saline will grow bacteria after 24 hours.
They are the larvae of a species of fly (calliphorids: Lucilia sericata; also known as
Pheaenicia sericata or greenbottle blowfly).
They are obtained from the University of California (Irving).