Debridement of Wound & its type

Debridement of Wound

• Debridement is defined as the removal of foreign material and dead or damaged tissues.

• Removal of dead or infected tissues is important to prevent or control bacterial growth, encourage normal cellular activity in the wound bed, and enhance the rate of tissue repair.

  

  Fig. 1: Debridement of wound
  

  
  

Non-selective Debridement

Removal of both necrotic and living tissues.

1. Wet to Dry Dressings- 

1. A wet to dry (WTD) dressing consists of wet gauze applied to the wound bed and allowed to dry on the bed. 

2. Removal of the dry dressing debrided the wound, pulling away any cellular material that has adhered to the gauze. 

3. This method of debridement removes necrotic tissue, endogenous fluids, fibrin, and other calls.

2. Surgical Debridement

1. Surgical Debridement provides rapid results when treating life-threatening necrosis, a large wound, tunneling wound, or infected bone.

2. Wide excision, removing necrotic and living tissues under anesthesia.

3. Pulsatile Lavage with Suction

1. PLWS provide non-selective debridement.

2. It is a method of wound irrigation (forceful irrigation) combined with suction.

3. Suction removes the irrigation fluid, wound exudate, and loose debris.

Selective Debridement

Selective debridement removes only necrotic tissues.

1. Sharp Debridement

1. Sharp debridement is defined as the removal of dead or necrotic tissue or foreign material from and around the wound by the use of sterile instruments such as a scalpel, scissors, or forceps.

2. It is contraindicated for:

1. Vascular wound with limited blood flow.

2. Wound with tunneling (when wound bed cannot be seen)

3. Dry gangrene

4. Pressure ulcer on heel covered with dry eschar.

5. Patients with low platelets count on anticoagulants.

2. Enzymatic Debridement

1. It is a type of selective debridement that uses topical agents containing enzymes that dissolve necrotic tissues.

3. Autolytic Debridement

1. Autolytic debridement uses the endogenous enzymes on the wound bed to digest necrotic tissue and promote granulation tissue formation.