At the end of this chapter, the learner will be able to:
Discuss the contribution of debridement to wound bed preparation.
Define the types of debridement currently used in wound care practice.
Differentiate selective from nonselective debridement.
Select the appropriate type of debridement for patients whose wounds would benefit from the procedure.
Debridement as a Component of Wound Bed Preparation
Wound bed preparation is the global management of chronic wounds, which includes the goals of removing necrotic tissue from the wound, reducing the wound bacterial burden, managing the moisture content, and ensuring that the wound edges are conducive to cellular migration for resurfacing the wound (FIGURE 12-1). These components of wound bed preparation contribute to the correction of abnormal wound repair with the goal of facilitating the process of wound closure and subsequent healing. Adequate wound bed preparation is required prior to the use of advanced wound care therapies, such as tissue-engineered cellular and acellular devices, other biological wound interventions, collagen, and negative pressure wound therapy.1,2
The components of wound bed preparation are expressed in this paradigm of DIME, and can guide the clinician in the principles to facilitate wound healing.
Debridement of necrotic tissue from a wound bed is a key component of preparing a chronic wound for closure and subsequent healing (FIGURE 12-2).3-12 Numerous evidence-based wound care guidelines describe the importance of adequate and repeated debridement as a fundamental intervention for chronic nonhealing wounds. One of these well-known international documents is the European Pressure Ulcer Advisory Panel (EPUAP) and the National Pressure Ulcer Advisory Panel (NPUAP) guideline Pressure Ulcer Prevention and Treatment: Clinical Practice, which states several reasons to debride a chronic wound (TABLE 12-1).13
The presence of necrotic or devitalized tissue on the surface of a wound prevents accurate assessment of the extent of tissue destruction or depth of the wound.
Wound with necrotic tissue After a partial forefoot amputation, this foot wound has a large amount of necrotic tissue, both eschar and slough, that requires debridement in order for healing to progress.
Table 12-1Reasons to Debride Chronic Wounds12,13 |Favorite Table|Download (.pdf) Table 12-1 Reasons to Debride Chronic Wounds12,13
▪ Remove necrotic tissue
▪ Decrease the bioburden
▪ Remove senescent cells
▪ Decrease stimulation of inflammatory cell production
▪ Remove callous, rolled edges (epibole14)
▪ Facilitate angiogenesis
▪ Prepare wound bed for skin equivalents/growth factors
▪ Prepare wound bed for flap/graft
▪ Determine depth of tissue destruction