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Types of Wound Debridement

Autolytic Debridement:

Description:

  • Autolysis uses the body's own enzymes and moisture to re-hydrate, soften and finally liquefy hard eschar and slough. Autolytic debridement is selective; only necrotic tissue is liquefied. It is also virtually painless for the patient. Autolytic debridement can be achieved with the use of occlusive or semi-occlusive dressings which maintain wound fluid in contact with the necrotic tissue. Autolytic debridement can be achieved with hydrocolloids, hydrogels and transparent films.

Best Uses:

  • In stage III or IV wounds with light to moderate exudate

Advantages:

  • Very selective, with no damage to surrounding skin.
  • The process is safe, using the body's own defense mechanisms to clean the wound of necrotic debris.
  • Effective, versatile and easy to perform
  • Little to no pain for the patient

Disadvantages:

  • Not as rapid as surgical debridement
  • Wound must be monitored closely for signs of infection
  • May promote anaerobic growth if an occlusive hydrocolloid is used

Enzymatic Debridement:

Description:

  • Chemical enzymes are fast acting products that produce slough of necrotic tissue. Some enzymatic debriders are selective, while some are not.

Best Uses:

  • On any wound with a large amount of necrotic debris.
  • Eschar formation

Advantages:

  • Fast acting
  • Minimal or no damage to healthy tissue with proper application.

Disadvantages:

  • Expensive
  • Requires a prescription
  • Application must be performed carefully only to the necrotic tissue.
  • May require a specific secondary dressing
  • Inflammation or discomfort may occur

Mechanical Debridement:

Description:

  • This technique has been used for decades in wound care. Allowing a dressing to proceed from moist to wet, then manually removing the dressing causes a form of non-selective debridement.
  • Hydrotherapy is also a type of mechanical debridement. It's benefits vs. risks are of issue.

Best Uses:

  • Wounds with moderate amounts of necrotic debris

Advantages:

  • Cost of the actual material (ie. gauze) is low

Disadvantages:

  • Non-selective and may traumatize healthy or healing tissue
  • Time consuming
  • Can be painful to patient
  • Hydrotherapy can cause tissue maceration. Also, waterborne pathogens may cause contamination or infection. Disinfecting additives may be cytotoxic.

Surgical Debridement:

Description:

  • Sharp surgical debridement and laser debridement under anesthesia are the fastest methods of debridement.
  • They are very selective, meaning that the person performing the debridement has complete control over which tissue is removed and which is left behind
  • Surgical debridement can be performed in the operating room or at bedside, depending on the extent of the necrotic material.

Best Uses:

  • Wounds with a large amount of necrotic tissue.
  • In conjunction with infected tissue.

Advantages:

  • Fast and Selective
  • Can be extremely effective

Disadvantages:

  • Painful to patient
  • Costly, especially if an operating room is required
  • Requires transport of patient if operating room is required.

 Maggots

Click here to see our new section on Maggot Debridement Therapy written by Dr. Ronald Sherman.

These images were supplied by David Janssen, M.D. 

Dr. Janssen used to have a very detailed website, but now it's gone.

Place your mouse over each image for an explanation.

 

1. Wound with Duoderm

2. Wound with Duoderm, maggots and applying chiffon.

3. Wound with Duoderm, maggots and chiffon.

4. Wound with Duoderm, maggots, chiffon and 2nd layer of Duoderm.

5. Wound with Duoderm, maggots, chiffon, 2nd layer of Duoderm and Kerlix wrap.

6. Wound after 2 days of dressing.

7. Removal of dressing

8. Maggots on the wound.

9. Removal of maggots.

 

 


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