Understanding Wound Debridement: Essential Insights for Today’s Treatments

Talk to a wound care provider and chances are they’ll have quite the story to share about the first time they saw or conducted a wound debridement. Wound debridement is a crucial aspect of wound care, as it can significantly speed up the healing process by removing dead tissue and foreign material from a wound using various debridement techniques. While it may be a procedure that some may prefer to avoid, performing wound debridement effectively is vital for healing as well as improving overall outcomes and managing risk.

As a crucial and fundamental part of wound care, let’s review the process of wound debridement, why it is necessary, the types of patients who need it, and how technology and advanced products are helping to improve clinical approaches to debridement.

What is Wound Debridement?

First, the basics. Wound debridement procedures are medical procedures that entail the removal of dead tissue, damaged tissue, or infected tissue from a wound to stimulate healing. Surgical debridement, one of the methods used, involves removing hyperkeratotic, infected, and nonviable tissue using a scalpel or special scissors.

Wound debridement is a task typically conducted by certified wound specialists (CWS), RNs, LPNs, or physicians. The choice of provider often depends on the nature and severity of the wound and the practice setting. Some clinicians debride wounds daily; others may only perform the procedure for more serious wounds, considering healthy tissue and dead tissue, along with wound infections persisting or subsiding.

Your role in this process is crucial, and your expertise is what ensures the best possible outcome for the patient.

According to Wound Source, the 5 primary methods of debridement can be remembered through the mnemonic BEAMS:

• B = Biological debridement. This method uses sterile maggots (known as maggot debridement therapy) that consume dead tissue or non viable tissue, while sparing surrounding healthy tissue. Maggot debridement or maggot therapy and larval therapy, while sounding abnormal when speaking about proper wound care, do in fact promote healing. Unhealthy tissue is removed along with dead tissue and dead skin, making this a common debridement procedure.
• E = Enzymatic debridement. Apply topical enzymes to digest necrotic tissue, known as enzymatic debridement. Chemical enzymes help manage pain while reducing necrotic material.
• A = Autolytic debridement. Autolytic debridement has the provider rely on the body’s enzymes and moisture to break down dead tissue, and occlusive or semi-occlusive dressings facilitate autolytic debridement. Autolytic debridement is not suggested for use with infected wounds.
• M = Mechanical debridement. Mechanical debridement deploys physical means, such as wet-to-dry dressings or hydrotherapy, to remove dead tissue.
• S = Surgical debridement. Surgical debridement uses instruments to remove necrotic tissue. It is often used for large wounds with significant amounts of dead tissue. In surgical debridement, dead tissue or nonviable tissue may be removed with surgical instruments, such as a scalpel. This known as “sharp debridement”. Sharp debridement will help the clinician or person perfoming surgery to better visualize the diabetic foot ulcer, for example, while the patient is comfortably unaware of the wound, under general anesthesia in the operating room and there for does not experience pain.

Method of Debridement: Pros and Cons

Each debridement method, whether surgical debridement, sharp debridement, or non-surgical debridement, falls under various debridement options, each with its own indications, advantages, and limitations. The choice of debridement method is contingent upon factors such as the wound type, healthy tissue pain, viable tissue vs. dead tissue or nonviable tissue present in the wound, the patient’s overall health, the wound’s location, potential diabetic foot ulcers, severity, and if nonviable tissue, dead tissue, or even viable tissue is ideal for the healing process. Or, potentially, if it is infected tissue and poses a greater, more immediate threat to not just the surrounding tissue, but to the patient’s overall health.

Why is Debridement Important?

Whether autolytic debridement, maggot therapy, nonsurgical debridement (or the opposite, deploying surgery or “sharp debridement” for a chronic wound) or mechanical debridement, one thing is clear: the debridement process is crucial for several reasons:

Debridement promotes the healing process

Debridement benefits include reducing the bacterial load in the wound, which is essential for creating a conducive environment for tissue and wound healing. Such is the case with mechanical debridement, where hydrotherapy may be used to remove dead tissue.

Debridement prevents infection

Necrotic tissue can harbor bacteria, leading to bacterial growth factors leading to infections that can spread to other body parts, corrupting additional dead skin or dead tissue and promoting further unhealthy tissue. The debridement effectiveness in preventing such infections is crucial.

Keeping a wound clean is essential. Mechanical debridement is appropriate for both noninfected wounds and infected wounds, while enzymatic debridement is not recommended for large and severely infected wounds. Autolytic debridement is also not appropriate for infected wounds.

Debridement reduces inflammation

Debridement outcomes can significantly reduce ongoing inflammation. Dead tissue often delays healing and leads to further tissue damage, while increasing pain and preventing the growth of new tissue. As such, it becomes important to rid the patient of dead tissue.

Improves wound assessment

Debridement assessment helps healthcare providers assess the wound and surrounding tissue more accurately by exposing the underlying healthy tissue, reducing wound fluid, and helping to keep the wound clean, preventing any/further dead tissue where possible.

Which Patients with Necrotic Tissue Need Debridement?

Debridement indications typically include a wide range of wound patients, such as those with diabetic foot ulcers, pressure, and venous ulcers, as well as those with severe burns or infected surgical incisions.

Other factors can affect the need for debridement

Debridement criteria are typically necessary for old wounds that aren’t healing properly and chronic wounds that are infected and worsening. It’s also recommended if there’s a risk of complications from wound infections. Factors such as poor circulation and inadequate care can contribute to the need for debridement, but these criteria are not exclusive.

What Role Do Advanced Technologies Play in Enzymatic Debridement?

The ability to assess wounds effectively, accurately, and quickly is crucial in deciding whether a wound needs debridement, regardless of the patient’s age or setting. The advent of mobile digital wound imaging technology has significantly impacted the wound field, offering numerous benefits to patients and healthcare providers, down to the person performing debridement advancements.

In fact, the genesis for Net Health’s AI-powered wound care solution, Tissue Analytics, came when the founders, Kevin Keenahan, Net Health’s Chief Product Officer, and his colleague Josh Budman, witnessed a debridement.

One of the advanced techniques used in wound care is wound irrigation, which involves selective mechanical debridement, therapeutic irrigation with suction, and directed wound irrigation.

The aforementioned two were going through a biomedical engineering master’s program at Johns Hopkins University. During a rotation in the ICU, they witnessed a debridement. “This stark and distressing procedure highlighted the significant gaps in wound care compared to other medical fields,” said Keenahan. “Our elective rotation in the wound clinic further underscored the complexities of treating chronic wound care patients and the challenges in documenting and communicating outcomes across different care settings.”

Optimal wound documentation of the wound care process and automatically and objectively measuring help predict at-risk wounds. These are critical in the debridement process as well as many other areas of wound care.

What Can We Do to Improve the Debridement Process for Wound Healing?

While adopting proven wound technologies is an essential strategy to stay ahead of the challenges and opportunities related to wound care debridement, there are other debridement strategies to consider.

Here are a few other steps to consider as it pertains to debridement and healing wounds:

1. Stay Informed: Keep up-to-date with evidence-based guidelines and recommendations. Understand wound types (e.g., pressure ulcers, diabetic ulcers) and their specific care requirements. Autolytic debridement, which utilizes the body’s own enzymes and moisture to rehydrate and soften necrotic tissue. Autolytic debridement is a selective and virtually painless method best suited for wounds with non-extensive dead tissue and no infection present.
   
2. Ensure the implementation of a patient-centered approach: Tailor debridement strategies to individual patient wound needs. Minimize wound discomfort and prevent complications by adhering to best practices, such as using antibacterial substances, sterile saline, a sterile catheter tube when needed, and practicing proper therapeutic irrigation. Lastly, while obvious, a sterile operating room that minimized foreign material before general anesthesia, and post-surgery, ensuring the patient follows a doctor’s instructions pertaining to caring for the wound and surrounding healthy tissue.
   
3. Participate in and encourage the development of educational courses and refreshers for all wound care providers: Develop wound programs, courses, etc., through associations, experienced providers, and partners, especially technology providers, to ensure solutions are used correctly and effectively. Debridement methods could be one such course.
   
4. Analyze performance and outcomes data: See if there are specific areas related to debridement where you may be experiencing problems or performing below your peers. Analyze wound data to see if, when, and with whom you see any problems. Is it within providers on a specific floor, with certain wounds, at a specific time? Is the wound reducing in size? Is new tissue, new healthy tissue, beginning to show itself around the site of the wound? How is blood flow? Have all potential bacterial growth factors been addressed?
   
   If it is a diabetic foot on a patients left leg, have you educated the patient on how to best care for the tissue? Are they aware of methods to reduce future wounds? The site of new tissue and removing dead skin or dead tissue isn’t enjoyable for patients. Therefore, all measures should be taken to ensure tissue is cared for, removing dead skin and dead tissue completely. Additionally, non viable tissue is documented and transparent films allow for visibility into the wound site.

It’s also helpful to keep an eye out for new wound products and procedure for wounds in the field. New therapies like DNA-digesting enzymes that break down necrotic tissue more effectively and the use of ultrasonic sound waves are some of the more exciting advances in debridement techniques.

Surgical Debridement Is a Vital Procedure for Providers and Patients

We hope this blog highlights the debridement importance and why wound debridement stands as a cornerstone in the treatment of chronic wounds and promotion of healthy tissue, crucial for both wound providers and wound patients, and essential for promoting wound healing.

Diving into the various debridement methods, understanding the patient profiles that benefit most, and leveraging cutting-edge mobile digital technology can dramatically boost the efficiency and effectiveness of wound care practice.

Whether you’re a seasoned wound care specialist or new to the field, embracing these wound debridement insights and technologies will arm you with the tools needed to overcome the challenges of wound debridement, ensure your patients receive optimal care, and optimize your facility’s performance and outcomes.