Wound Debridement

Wound Debridement

Wound Debridement is the medical procedure through which the non-living tissue is removed off wounds, including burns and pressure ulcers. This procedure is employed in order to allow for faster healing of the wounds, as the presence of necrotic tissue slows down the natural process of tissue regeneration. Also, the necrotic tissue may become infested with invasive agents such as bacteria, becoming a possible source of infection – not to mention a source of unpleasant odor. Even if the invasive agents do not cause an infection, they may cause local inflammations which will further strain the immune system capabilities to fight infections. Wound Debridement is also performed in order to ensure that no pus pockets are concealed by the existing necrotic tissue. These pus pockets, if left undiscovered, may develop into abscesses which will further cause general infections and ultimately, amputation or death.

It is not always best to perform a debridement of the wound, as the eschar that forms (the crust of dead tissue covering the wound) may be stable and offer better protection for a wound that is not inflamed. The specialized health care professionals will asses the patient’s condition and his or her medical history before deciding if Wound Debridement is necessary. The natural healing process may be hindered by smoking or medication therapies, and the cause of the wound and the treatment being applied also influence the healing process. In other situations, the wounds affect areas with low or impaired blood circulation – debridement is not recommended in these cases as proper healing may not be possible.

Although in general the debridement procedures cause pain, the patients tolerate them well; also, their management may be more aggressive in order to ensure complete elimination of the dead tissue. In certain situations, subsequent debridement may be necessary, after initial procedures have been applied.

Wound Debridement Description

There are multiple Wound Debridement techniques available; in this chapter, we aim to familiarize you with the most commonly used procedures, by providing a short description for each.

Autolysis is a procedure which uses the organism’s own enzymes and fluids to liquefy eschar and slough through a gradual process of re-hydration. This debridement technique is selective and only results in the necrotic tissue being liquefied. The success of this procedure relies on the use of dressings, which keep the necrotic tissue in contact with the body fluids. Hydrogels, hydrocolloids and transparent films may help ensure the success of the autolytic debridement.

Wound Debridement with use of chemical enzymes is performed by producing slough of dead tissue; the chemical agents are fast acting products, and they may be selective in the debridement or not. Generally, this type of debridement is best used on wounds presenting large amounts of necrotic tissue and eschar formation.

The most commonly employed form of debridement is the mechanical debridement. This is a procedure which has been employed for a long time in medical practice. It involves allowing the dressing covering the wound to become wet, and then manually removing it. Hydrotherapy is also considered to be a form of mechanical debridement.

Surgical Wound Debridement (either performed with sharp utensils or, more recently, with laser) is currently the fastest method of removing necrotic tissue from a wound. This procedure may be performed under anesthesia, in order to limit the pain inflicted on the patient. This is a very selective procedure, as the specialized health care professional has full control over the removal of the dead tissue while preserving the healthy and new tissue around it. This type of debridement may only be performed at the patient’s bedside or in the operating room.

Another, more controversial procedure is the debridement of wounds using fly maggots. Studies have shown that the maggots will only consume the necrotic tissue leaving the surrounding healthy tissues intact; complete debridement is achieved within a day or two, with a precision far superior to human surgical procedures.

Wound Debridement Related Medication

Wound Debridement (especially surgical debridement) is commonly preceded by the administration of local anesthetics in order to block the pain and allow the health care professionals to proceed with the operation in a comfortable manner for the patient. Depending on the wound position, severity and dimensions, the patient may be placed under local or general anesthesia for the duration of the debridement operation. The condition of the patient and the severity of the wound will allow the supervising physician to determine whether the patient should be put under local or general anesthesia, as well as the type of anesthetic which should be employed.

In the case of local anesthesia, epidural antibiotics are commonly employed; the pharmaceutical agent is injected in or into the area surrounding the spinal cord through a needle, causing temporary loss of feeling in the target area for a defined period of time – typically for several hours. Some of the common anesthetic agents used for local anesthesia during Wound Debridement are Lidocaine, Prilocaine, Bupivicaine and other amide based agents.

For severe injuries, general anesthesia may be preferred, using either opioid anesthetic substances (Fentanyl, Alfentanil, and Remifentanil) or non-opioid agents (benzodiazepines such as Diazepam or Midazolam, or barbiturates such as Thiopental or Methohexital). These are administered intravenously through an injection, and cause the patient to be unconscious and blocking all pain for the duration of the procedure. It is also possible for the patient to be administered inhaled general anesthetic agents. Examples of such agents are Sevoflurane, Halothane, Isoflurane, Desflurane and Nitrous Oxide; typically, the patient will be constantly administered inhaled anesthetics for the entire duration of the procedure.

It is common practice that the patient is administered prophylactic doses of antibiotic medication. This is performed in order to help his or her immune system fight infections. The specifications regarding the antibiotic medicine to be used and the medication dosage will be determined by the supervising health care professional after carefully assessing the patient’s condition and the risk factors. In most cases, the patient is administered a single dose of medication prior to the beginning of the Wound Debridement procedure, however additional doses may be administered later on as needed.