Introduction
Wound debridement helps to clean the wound and promote healing. The wound is generally made free from nonviable tissues, infectious material, and moisture to provide an environment for vital tissues to grow.
Debridement is an important step in the healing of the wound. It is considered to play a fundamental role in wound management. Many different types of debridement are available that have their own advantages and disadvantages. Minor wounds usually heal on their own using the body’s immune reaction. The large wounds that are infectious have an increased amount of dead tissue. In such a situation, the body’s immune system alone is not enough and needs additional assistance by wound debridement. It is most helpful in individuals with diabetic ulcers as their immune system is compromised.
Why Is Wound Debridement Done?
Wound debridement is done to:
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Remove the necrotic tissue and clean away the infected material.
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Reduce the multiplication of bacterial cells within the wound.
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Collect samples from the tissue to examine them and start the treatment with appropriate antibiotics.
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Clear the wound area to place any skin grafts if necessary.
What Are the Types of Wound Debridement?
There are five types of debridement. They are:
1. Autolytic Debridement
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This type of debridement occurs naturally in the body and is one of the slowest processes.
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Certain types of cells produced in the body called phagocytic cells (cells that engulf the bacteria and kill them) and proteolytic enzymes (enzymes that break down the protein to decrease the inflammation), take part in this process.
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A moist environment is needed for this process.
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The body’s enzymes and the moist environment under the dressing enhance the necrotic (dead tissue) material in the wound to soften.
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The softened dead tissue is then separated from the wound site.
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The dressings used here are hydrocolloid, hydrogel, and transparent films.
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Since it is a slow process, an alternate type of debridement is used if the wound is not healed in one or two days.
2. Biological Debridement:
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This type is known as ‘larval therapy,’ where sterile larvae of Lucilia sericata (green bottle fly) are used to kill the bacteria in the wound. Maggots are another larva of a fly and serve the same purpose.
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These larvae kill only the dead tissues and leave the vital tissues unaffected.
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This type of debridement is helpful in large painful wounds.
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It is not used in conditions such as abdominal wounds and wounds that are found near an area of septic arthritis (infection of a joint that has spread through the blood to another part of the body).
3. Enzymatic Debridement:
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A proteolytic enzyme, collagenase, is used in this type.
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Collagenase breaks down the collagen substance in the infected or dead tissues and removes them.
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Dressings that retain moisture enhance the debridement.
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This type is not recommended for large infected wounds.
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It is expensive and can be used along with surgical debridement.
4. Mechanical Debridement:
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Here, mechanical force is used in wound debridement.
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This process removes both dead and vital tissues.
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The mechanical force is delivered by wet-to-dry, pulsatile lavage, or wound irrigation.
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In the wet-to-dry method, a moist dressing is placed on the wound. The healing takes place under a wet dressing and must be changed every four to six hours. The wound bed is not allowed to dry.
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In the pulsatile lavage method, an electric device directs a stream of irrigating solution into the wound to clear away the debris.
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The wound irrigation method delivers the fluid to the wound with gentle pressure. Too much pressure that spreads the fluid out of the wound area is avoided.
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Hence, mechanical debridement is helpful in all types of wounds.
5. Surgical Debridement With Sharp Instruments:
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The procedure is done under local anesthesia.
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A well-trained surgeon performs the procedure.
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A sharp instrument like a scalpel blade removes dead and infected tissues.
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The skin around the wound is cleaned, and the depth of the wound is visualized by probing with a metal instrument.
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The dead tissues are removed and washed away.
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This method can also be combined with other types of debridement.
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Complications might occur due to the debridement process, such as bleeding or allergic reactions to anesthesia.
The first four types are non-surgical methods, and the last type is a surgical procedure. The doctor decides which type of wound debridement to use for proper management. A combination of two methods is also considered for effective wound healing.
What Are the Benefits of Wound Debridement?
The following are the benefits of wound debridement:
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Removing the dead tissue from the wound provides a good healing environment and space for the vital tissues to grow.
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In diabetic patients with a foot ulcer, the debridement of the ulcer relieves the symptoms and reduces inflammation. This allows the patient to walk more comfortably.
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The wound debridement process eliminates the bacteria that could provide pain and swelling.
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Complications like amputation (loss) of any body part are avoided by early treatment with wound debridement.
What Are the Complications of Wound Debridement?
The possible complications that could occur with wound debridement include:
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Allergic reactions to anesthesia.
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Excessive bleeding from the wound site.
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Persistence of pain even after debridement.
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If the infection within the wound is not cleared completely, further growth of infectious bacteria occurs.
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In some procedures like mechanical debridement, the vital and dead tissues are removed simultaneously due to excessive force.
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The wound healing may get delayed.
The factors mentioned above are the problems that may arise after wound debridement. The factors that increase the risk of developing such problems are:
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The habit of smoking in patients with a wound delays the healing process. Smoking reduces the blood supply, and oxygen does not reach the healing tissues. Due to inadequate blood and oxygen supply, bacteria multiply, and the healing process slows down. Hence, the patients must quit smoking.
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The habit of alcohol consumption is also avoided.
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Patients with immunocompromised conditions like diabetes are also at high risk of delayed healing and re-infection.
Conclusion
Wound healing and reducing infectious bacteria is the main goal of wound debridement. Different debridement methods are combined to enhance the healing process and provide a wound bed suitable for healthy tissues to grow. Complications may arise due to many reasons. The complications are avoided if the patient follows certain precautions to reduce the risk. The doctor must frame a proper management protocol for a good healing outcome.