CHAPTER TWELVE: Wound Debridement

CHAPTER OBJECTIVES

At the end of this chapter, the learner will be able to:

1. Discuss the contribution of debridement to wound bed preparation.

2. Define the types of debridement currently used in wound care practice.

3. Differentiate selective from nonselective debridement.

4. Select the appropriate type of debridement for patients whose wounds would benefit from the procedure.

INTRODUCTION

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

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

Epibole (FIGURE ...