Debridement: Procedure, Types and Risk Factors

It is the process of removing dead or infected tissue from a wound to make a healthy tissue form, completing the space left by the wound.

The removal of all that damaged tissue helps accelerate the skin’s regeneration process, quickly establishing a new layer of skin.

It is not possible to properly evaluate an open wound until the damaged tissue is removed. Wounds that contain ischemic or necrotic tissue take longer to close and heal.

This necrotic tissue provides an ideal growth medium for bacteria, especially for Bacteroides spp. and Clostridium perfringens causing the gas gangrene so feared in diabetic patients.

Debridement is also used to remove pockets of pus in the skin called abscesses. Abscesses can invade the bloodstream and become a general infection (sepsis).

Infected or necrotic tissues can lead to amputation and even death.

Process

Currently, five types of debridement are known:

  1. Surgical debridement

Surgical debridement is performed with the help of scalpels, lasers, forceps, scissors and other instruments, in addition to the use of anesthesia.

This is the method most used in large wounds that have deep tissue damage, or in very painful wounds.

The skin surrounding the wound is cleaned and disinfected, the dead tissue is cut, the wound is subsequently washed to remove any residue or free tissue.

In some cases, you may need to perform grafts because of the amount of tissue removed in the procedure.

Advantage
  • There is excellent control over what and how much fabric is removed.
  • It is the fastest way to achieve cleansing of wounds.
  • Accelerates the healing process.
Disadvantages
  • It is more expensive if an operating room is required.
  • There are risks inherent to general anesthesia.
  • It is painful for the patient.

    2. Chemical debridement

In this case a debriding medication is applied to the wound.

Enzymes present in the drug dissolve any dead tissue in the wound, then cover the wound with a bandage.

They are the most used in wounds with a large amount of necrotic or eschar formation.

Advantage
  • It is faster than autolytic debridement.
  • If done correctly, there is little risk to healthy tissue.
Disadvantages
  • The patient must have prescribed the chemical agent and it can be quite expensive.
  • One must be very careful that healthy tissue does not come in contact with the chemical agent.
  • A secondary bandage may be necessary to absorb the exudate.
  • Chemical debridement can cause discomfort to the patient such as a burning sensation and an increase in the pain of the wound.

    3. Mechanical debridement

It is one of the oldest procedures.

In mechanical debridement, a variety of methods are involved, all of which use mechanical force in order to eliminate dead or infected tissue.

In a whirlpool tub with sterile water at high speeds, wet bandages are placed over the wound, as this dressing dries, absorbs the wound material, when the bandage is removed, part of the tissue comes with it.

It is the most appropriate procedure for wounds with large amounts of necrotic waste.

Advantage
  • It is more economical, due to the fact that gauze is the most used material.
  • The bandage changes are simple, so the patient can be taught to change their own bandage.
Disadvantages
  • The healthy or scar tissue can be eliminated in practice.
  • It takes a long time since the dressings must be changed often, the patient must spend a lot of time in the whirlpool bath to achieve the desired goal.
  • It can be quite painful for the patient.
  • Infection is a risk when hydromassages are used due to waterborne contamination.

    4. Autolytic debridement

In this form of debridement is translated in helping the body to do its own cleaning of dead cells in the wound.

In this procedure special dressings are used that retain the exudates, byproducts of cellular decomposition, helping the body’s natural healing abilities to clean the wound.

This type of bandage is often used to treat pressure ulcers.

It will not be used for infected wounds or if you need a quick treatment.

Advantage:
  • There is no damage to the surrounding skin; It is selective for necrotic tissue.
  • The process is safe because it uses the body’s natural processes to eliminate the necrotic tissue wound.
  • It is very effective and easy to perform.
  • It is not painful for the patient.
Disadvantages
  • The process can take days or weeks.
  • The wound should be monitored for any signs of infection.
  • Anaerobic growth may occur when an occlusive dressing is chosen.

    5. Biological debridement

There is a fifth type of debridement: biological debridement whose procedure is performed using worms that have been cultured in a sterile environment.

The worms eat only necrotic tissue, so this type of therapy can be considered selective.

This method is gaining popularity, but some patients find the method somewhat painful and their apprehension of insects can hinder their use.

To make a decision about which is the most appropriate treatment, it is necessary to make the diagnosis and weigh the risks in the case of pre-existing diseases.

The duration of treatments depends on the type of debridement.

Surgical debridement is the fastest method.

Non-surgical debridement can take 2 to 6 weeks or more.

After debridement is performed, samples of the extracted tissue are sent to a laboratory for examination and diagnosis.

To achieve a rapid recovery, the wound and dressings should be kept clean and dry and medications should be administered according to the dosage and time prescribed.

Risk factors of the procedure

Factors that can increase the risk of complications include:

  • Infection.
  • Pre-existing medical conditions such as circulatory problems and diseases such as diabetes.
  • Smoking patients
  • Use of steroids or other immunosuppressive medications.
  • A bad diet.

It is possible that during surgical debridement, blood vessels tendons or other underlying structures are damaged during the diagnosis of the wound or during surgical debridement.

Bacteria on the surface can penetrate deeper into the body, causing more serious infections.

Symptoms of a complication

After debridement, a complication may occur, presenting the following symptoms:

  • Fever and chills.
  • Redness, swelling, increased pain, excessive bleeding or discharge at the wound site.
  • White, bluish, or calcareous black appearance of the tissue around the wound.