Wound Care

Training Module

WOUND DEBRIDEMENT

Wound Care Training Module - National Wound Care Committee

 Content

1. Introduction
2. Methods of Debridement

Wound Care Training Module - National Wound Care Committee

 INTRODUCTION

Process of removal of non viable

tissue and contaminants from a
wound to promote healing

Wound Care Training Module - National Wound Care Committee

 METHODS OF DEBRIDEMENT

1. Surgical Debridement
2. Autolytic Debridement
3. Enzymatic Debridement
4. Mechanical Debridement
5. Biological Debridement
6. Hydrostatic Debridement

Wound Care Training Module - National Wound Care Committee

 1. Surgical Debridement

• Removal of necrotic tissue by sharp

instruments
 Scalpels
 Scissors
 Curette
 Humby knife
 Electrical dermatome

Wound Care Training Module - National Wound Care Committee

 • Indications:

Thick eschar Devitalized Callous

tissue formation

Wound Care Training Module - National Wound Care Committee

 Surgical Debridement

Suitable
Or
Not Suitable ?

Wound Care Training Module - National Wound Care Committee

 Assessment of Wound Indicated
for Surgical Debridement
1. Nature of the necrotic or ischaemic tissue
2. The risk of spreading infection and use of antibiotics
3. Presence of medical conditions causing the wound
4. The extent of ischaemia in wound tissues
5. The location of wounds in the body
6. Types of analgesia to be used during the procedure
7. Possible complications

Wound Care Training Module - National Wound Care Committee

 Special consultation may be
required in the following condition
1. Vascular insufficiency
2. Gangrenous wound
3. Risk of injuring vital structures
4. Coagulopathy (risk of bleeding)
5. Stable heel ulcer
6. Fungating/malignant wounds
7. Necrotic tissues involving neurovascular
8. Wounds of hand and face

Wound Care Training Module - National Wound Care Committee

 Basic Principles of
Surgical Debridement
1. Debride in stages to minimize damage to
healthy tissue.
2. Staying within a given a facial plane during
debridement avoids spreading bacteria into the
lower layers.
3. Small bleeders can be stopped by pressure.
Large bleeders require diathermy or ligation.
4. Pain control.

Wound Care Training Module - National Wound Care Committee

 Tissue differentiation
during debridement

VIABLE or NON VIABLE

Wound Care Training Module - National Wound Care Committee

 Tissue Non viable Viable
Fat Dull, Gray/brown to black Shiny yellow

Fascia Dull, Gray/brown to black Glistening White

Wound Care Training Module - National Wound Care Committee

 Tissue Non viable Viable
Muscle Dull red
Dark red/brown to gray Possible contraction if pinched

All tissue No sensation Good vascularity –

Avascular- no bleeding punctate bleeding
Frequently foul odor Little or no odor

**In case of periosteum, just leave it alone as it will granulate and will
accept skin grafts

Wound Care Training Module - National Wound Care Committee

 2. Autolytic Debridement
• Wound bed utilizes phagocytes and
proteolytic enzymes to remove non viable
tissue.
• Promoted and enhanced by maintaining a
moist wound environment.
• Mode of action
 Gently rehydrates dry necrotic tissue
 Provides moist wound healing environment
 Softens necrotic tissue

Wound Care Training Module - National Wound Care Committee

 3. Enzymatic Debridement

• Use of topically applied enzymatic agents.

• Stimulate the breakdown of non viable
tissue.
• Faster action than autolytic.
• Examples: Honey, Clostridiopeptidase A,
Fibrinolysin with DNAse.

Wound Care Training Module - National Wound Care Committee

 4. Mechanical Debridement

① Wet to dry gauze

• Using gauze to peel the necrotic tissue
from wound bed.
• Can be very painful.
• Need to give analgesic prior to the
procedure.

Wound Care Training Module - National Wound Care Committee

 ② Scrubbing
• Using the blunt edge of the scalpel or
forceps to remove biofilm, debris or
necrotic tissue.
• Can be done during bed side dressing.

③ Whirlpool
• Utilizes low pressure water force to
cleanse and debride the wound bed.
• Less harmful to normal cells.

Wound Care Training Module - National Wound Care Committee

 ④ Wound irrigation
• Using non antiseptic cleansing solution
to irrigate and debride the wound.

Wound Care Training Module - National Wound Care Committee

 5. Biological Debridement
• Using sterile maggots for debridement of
wounds in humans.

** refer MDT topic

Wound Care Training Module - National Wound Care Committee

 6. Hydrostatic Debridement

• Using a high power hydrostatic debrider.

Wound Care Training Module - National Wound Care Committee

 • Surgical debridement of wounds.
• Excise tissue with a stream of saline.
• Combined localised vacuum
removing excised tissue
immediately.
• Holds, cuts and removes tissue at
the same time.
• More precise and selective than
using scalpel.
• Enable surgeon to precisely remove
the devitalised tissues and preserves
healthy tissues.

Wound Care Training Module - National Wound Care Committee

 TAKE HOME MESSAGES
• There are many types of debridement
methods.
• Gold Method = Surgical/Sharp
• Wound debridement is paramount to
create a stable wound.

Wound Care Training Module - National Wound Care Committee

 REFERENCES
• Comprehensive Wound Management 2nd ed; Glenn L.Irion , Phd.
PT.CWS
• Sharp Debridement; Vince Lepak, PT, MPH, CWS
• Loehne, H.B. (2002). Wound debridement and irrigation. In
L.C.Kloth and J.M. McCulloch
• Bergstrom,N.,Bennet,M.A.,Carlson,C.E.,et al(1994).Treatment of
pressure ulcers.
• Leaper D (2002) Sharp technique for wound debridement World
Wide Wounds December
• NICE (2001) Guidelines on Pressure ulcer risk assessment and
prevention NICE London
• Guidelines for the Assessment and Management of
Wounds(2006);NHS

Wound Care Training Module - National Wound Care Committee

 THANK YOU

Wound Care Training Module - National Wound Care Committee