debridement

Debridement is the medical removal of nonviable, contaminated, or necrotic tissue from a wound to improve the healing environment. By reducing dead tissue and bioburden, it helps expose a viable wound bed, speed healing, and enhance the effectiveness of dressings, antibiotics, and closure procedures.

Wounds may contain necrotic material such as eschar or slough, alongside viable tissue like granulation tissue. Debridement targets the nonviable components while preserving healthy tissue when possible. Methods are chosen based on wound type, infection, patient factors, and available resources.

Sharp or surgical debridement uses a scalpel, scissors, or curettes to rapidly remove necrotic tissue, often performed at the bedside or in an operating room with anesthesia. Mechanical debridement involves physical removal through wet-to-dry dressings, hydrotherapy, or wound irrigation. Enzymatic debridement applies topical enzymes to dissolve necrotic tissue. Autolytic debridement relies on moist, occlusive dressings and the body's own enzymes to liquefy necrotic tissue. Biological debridement uses sterile larvae (maggots) that selectively consume necrotic tissue.

Procedure and care: debridement is preceded by wound assessment, infection control, and consideration of perfusion and anesthesia needs. Techniques aim to minimize pain and damage to viable tissue. Debridement may be followed by appropriate wound dressings, infection management, and strategies to promote granulation and closure. Repeated sessions may be required for extensive or chronic wounds.

Risks and considerations: potential risks include pain, bleeding, infection, and injury to surrounding structures. Contraindications and suitability depend on the method and clinical context, such as blood supply, infection status, and patient comorbidities. When used appropriately, debridement improves wound bed quality and can shorten healing time and enable subsequent closure or grafting.