Dr Abhishek Tiwari, Consultant

Dept. of Minimal Access, Robotic & Bariatric Surgery, Apollo Hospital, Delhi.

Debridement plays a pivotal role in wound management. To know when, when not and how much to debride requires experience and expertise. Debridement converts chronic into active wound by releasing growth hormones and removing bacteria. Edges of chronic wound have reduced DNA replication required for wound healing (reduced cytokine production) and chronic non-healing infected wounds produce abnormal metalloproteinases and they in turn prevent chemoattractants and growth factors essential for healing. Hence, debridement promotes wound healing by nullifying these inhibitory actions.

Two factors - ischemia and infection - decide the timing of debridement, i.e., revascularization of ischemic wound followed by when to debride is crucial. It takes few days to four weeks for visible revascularization effects (surgical bypass effects are quicker compared to endovascular procedure).

Judicious use of debridement is important as undue debridement may damage healthy epithelium and granulation.

Types of debridement:

1. Mechanical debridement

1. Wet to dry dressing: This method removes necrotic tissue and absorbs little exudate. It needs frequent dressing change.
2. Hydrotherapy (Whirlpool, Hubbard tank): Useful in patients with burns, crush injuries, arterial insufficiency, etc. This therapy helps to remove debris and bacteria, decreases wound pain and fever and helps to remove adhered dressing.
3. Pulsed lavage: Pressurized pulsed solution is used in this modality to irrigate and debride wound. It is contraindicated over exposed arteries, tendons, nerves, cavities and fascial wounds.
4. Jetforce: In this modality, focused stream of water droplets mixed with oxygen is used.
5. Ultrasonic therapy

Mechanical debridement to be performed

Hubbard tank

Pulse jet lavage

2. Chemical debridement:

Eusol

Enzymes

Daikin solution

3. Biological debridement: Maggots therapy (Lucilia sericata): It’s a facultative parasite and feeds on decaying tissue. They develop rapidly and do not invade internal organs. Maggots work by chemical debridement, removal of bacteria, change in pH of wound and release of growth factors.

4. Surgical debridement: Extensive removal of tissue, bone, muscle by a wound care specialist in OR with or without anesthesia, called as ‘shave therapy’ if complete excision is done with surrounding lypodermatosclerosis or ‘sharp debridement’ if done bedside or in OPD.

Venous Ulcer: needed EVLT & Sharp surgical debridement

Sharp Surgical debridement to be performed

Debridement plays most important role in wound management and is complete science in itself. Vascularity plays major role in wound debridement. Most important factor above all is expertise and acumen about when, how much and when not to debride.

Suggested Reading

1. Falanga V. Growth factors and chronic wounds: The Need to Understand the Microenvironment. J Dermatol. 1992;19:667-72.
2. Edwards R, Harding KG. Bacteria and wound healing. Curr Opin Infect Dis. 2004;17:91-6.
3. Armstrong DG, Lavery LA. Clinical care of the diabetic foot. Chapter 7. ADA; 2005.
4. Vachhrajani V, Khakhkhar P. Science of wound healing and dressing material. Chapter 3. Springer; 2020.
5. Tao H, Butler JP, Luttrell T. The role of whirlpool in wound care. J Am Coll Clin Wound Spec. 2013;4(1):7-12.
6. Evans H. A treatment of last resort. Nurs Times. 1997;93:62-5.