Wound Debridement

Updated 11/18/2022
Wound debridement, University Foot and Ankle Institute

What is wound debridement?

Wound debridement is one of several important steps in treating foot and ankle wounds, including diabetic foot ulcers. Debridement is the process of removing non-viable tissue from new or chronic wounds to promote healing. Debridement is different from wound cleansing, which means taking things out of a wound, like dirt or foreign objects. 

 

By removing it, healthy tissue is left behind to promote healing. After an injury or medical condition, if any dead or dying tissue remains, it might spread infection to other parts of the body. In the long run, the tissues won't help at all. Therefore, eliminating them will aid the body's healing process.

 

With a debridement, sometimes a "washout" technique is used. This is also called wound irrigation. Surgeons often use the term "I&D," which stands for "irrigation and debridement," to describe this type of procedure. Debriding wounds is a complicated medical process that requires a thorough look at the wound and the use of specialized treatments.

When is debridement of a wound necessary?

Overloading the body with dead or necrotic tissue from a wound that isn't healing might be detrimental to the body's capacity to produce new tissue. Furthermore, it can provide bacteria with the resources they need to multiply. Because of this, you can't save the damaged tissue, so debridement is needed for healing.

 

What are the types of debridement

If a serious wound — like a puncture wound — isn't healing well and doesn't respond to the first debridement method, a specialist may try another. There are different methods of debridement for different wound care needs, and different types may need to be tried. For example, surgical debridement may be followed by mechanical debridement in a severe wound with dead or dying tissue.

 

Sharp debridement 

Sharp debridement techniques are the most efficient. The two main types are sharp surgical, done by a surgeon, doctor, or podiatrist, and sharp conservative, which a trained clinician does. 

 

As the name suggests, sharp instruments — including scalpels, scissors, curettes, and forceps — are used to surgically remove the tissue.

 

A sharp surgical operation is invasive and requires the removal of some healthy tissue, while a sharp conservative technique is minimal and can be done at the bedside.

 

Autolytic debridement

In autolytic debridement, the necrotic tissue gets broken down with the help of the body's own enzymes. Your doctor will cover the wound with products that keep it moist to promote wound healing. Autolytic debridement takes the longest, and the amount of necrotic tissue present or the presence of infection can rule out this kind of treatment. 

 

Enzymatic debridement 

As part of enzymatic debridement, collagenase ointment (Santyl) is put on the wound bed daily. The ointment breaks down the collagen holding the dead tissue to the wound bed. This makes the dead tissue easier to remove. 

 

Compared to autolytic debridement, this technique moves along more quickly. However, it is still slower than sharp debridement.

 

Mechanical debridement

Mechanical debridement uses an outside force to remove dead tissue or eschar from the wound bed. This procedure eliminates both healthy and unhealthy tissue, so some discomfort may occur. 

 

Some mechanical debridement methods include scrubbing, a whirlpool, irrigation, pulse lavage, and wet-to-dry dressings. Wounds that are epithelializing or granulating — growing a fresh layer of tissue or skin — should not undergo mechanical debridement.

 

Biological debridement

While it may seem a thing of the past, maggot therapy is a still-practiced type of biological debridement in which sterile medical maggots remove dead tissue. As the maggots eat away the dead tissue, they kill any germs they come across and help the wound heal. 

 

However, this technique is not widely used as there are often better options.

 

What are the benefits of wound debridement?

Debridement is a vital part of treating wounds on the foot and ankle. This procedure removes diseased or otherwise damaged tissue from a lesion to help it heal faster, make it less painful, and keep it from getting infected.

 

The benefits of wound debridement include the following:

 

  • Removal of unviable tissue and foreign material.
  • Stimulation of healthy tissue growth.
  • Prevention of bacteria growth.
  • Improvement of healing time.
  • Reduction of pain.

 

What are the complications of wound debridement?

The possibility of complications during and after debridement exists, as with any medical surgery. By trusting your care to a highly-trained and specialized wound care surgeon, you can limit your risk of serious complications.

 

Complications of wound debridement may include: 

  • bleeding
  • growth of biofilm and wound infection
  • irritation or allergic reaction
  • healthy tissue damage
  • pain

 

There may be some unfavorable effects, but in most cases, the advantages are worth it. Debridement is essential for wound bed preparation and healing many foot and ankle wounds, like pressure ulcers, skin grafts, or leg ulcers.

 

Wound care after debridement

In most cases, wound healing takes 6-12 weeks. The extent and speed at which the wound heals are proportional to its severity, size, and location. How debridement is performed may also have an impact on healing time.

 

You must follow the instructions of your doctor after wound debridement. There will be less of a chance for complications, and it will heal faster.

 

Here are a few things to help with wound management:

 

  • Make sure to swap wound dressings regularly. Hydrocolloids and clear hydrogel dressings help you look for signs of infection.
  • The dressing needs to stay dry. Do not enter any water, including pools and hot tubs. Get the okay to shower from your doctor.
  • Maintain a sanitary environment around the cut. When touching a wound, always make sure to, first and foremost, clean your hands.
  • Cushion your wounds with the appropriate equipment. An injury to the foot or ankle may necessitate the use of crutches.
  • Even if you think you’re doing better, continue following the directions given by your doctor and attend any necessary follow-up appointments. 

 

How often should a wound be debrided?

In-office debridement is often performed every one to two weeks, depending on the type of wound. It’s possible debridement won't be needed more than once; in fact, excessive debridement harms the healing process.

 

When should you not debride a wound?

Debridement is not the right option when the dead tissue or gangrene is dry and there is no infection — like in the case of an ischemic diabetic foot. The devitalized tissue should be allowed to dry and slough away.

 

Worried about a foot or ankle wound? Contact UFAI’s wound care team

UFAI is nationally recognized for advanced wound care treatment — specializing in wounds of the feet. Our podiatrists have decades of combined experience managing the special circumstances surrounding all types of foot problems and injuries.

 

As one of Southern California’s largest and oldest podiatric healthcare practices, our wound care center offers multi-disciplinary medical care. With diagnostic testing — including vascular testing — available on-site, our patients are saved the time and hassle of running around to different diagnostic centers.

 

We are conveniently located throughout Southern California, and the Los Angeles area as our foot doctors are available at locations in or near: Santa Monica, Beverly Hills, West Los Angeles, Manhattan Beach, Northridge, Downtown Los Angeles, Westlake Village, Granada Hills, and Valencia, California. We accept over 1000 PPO health insurance plans, including Medicare.

 

If you want to learn more about how UFAI can help you, we encourage you to schedule a consultation with one of our foot and ankle specialists by calling (877) 736-6001 or making an appointment online.

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