Wound Debridement

When is debridement of a wound necessary? 

Dead and necrotic tissue from a wound negatively impacts your body’s ability to produce new tissue, increases your risk of further infection (including bone infection), and can prevent a wound from healing. If the infection is permitted to continue spreading, you may end up needing amputation of all or part of the infected foot to stop the spread of infection.

Chronic wounds often need debridement to begin healing. Diabetic patients often need wound debridement, especially for diabetic foot ulcers (DFUs), as poorly managed diabetes mellitus can decrease blood flow to the lower extremities and slow your body’s natural healing rate.

What are the types of debridement? 

There are different methods of debridement based on the type of wound, location of the wound, and the patient’s general health. Depending on how the wound responds to debridement, our wound care experts may try multiple techniques. For example, surgical debridement may be followed by mechanical debridement in a severe wound with dead or dying tissue.

Sharp debridement 

Sharp debridement is a type of surgical debridement in which a trained clinician uses sharp tools such as scissors and scalpels to cut away dead tissue. It is a fast and efficient technique but may require multiple treatments.

Sharp debridement gives our surgeons control over what tissue they remove. This technique can also be used to remove calluses that may form over damaged tissue.

Autolytic debridement 

Autolytic debridement is a more conservative method of debridement that uses your body’s own enzymes to break down necrotic tissue. One of our healthcare providers will cover the wound with moist coverings and let the enzymes do the rest. This is the slowest debridement treatment, but also the least invasive.

Enzymatic debridement 

A form of chemical debridement, enzymatic debridement uses collagenase ointment to break down the collagen holding the dead tissue to the wound bed. This makes the dead tissue easier to remove without damaging the surrounding soft tissue.

Compared to autolytic debridement, this technique moves along more quickly. However, it is still slower than sharp debridement.

Mechanical debridement 

Mechanical debridement encompasses a number of debridement options that utilize outside forces to remove dead tissue from the wound bed.

Some mechanical debridement methods include scrubbing, hydrotherapy, irrigation, pulse lavage, and wet-to-dry dressings. Wounds that are epithelializing or granulating — growing a fresh layer of tissue or skin — should not undergo mechanical debridement.

Biological debridement 

While it may seem a thing of the past, maggot therapy is a still-practiced type of biological debridement in which sterile medical maggots remove dead tissue. As the maggots eat away the dead tissue, they kill any germs they come across and help the wound heal.

However, this technique is not widely used as there are often better options.

What are the benefits of wound debridement? 

Debridement is a vital part of treating wounds on the foot and ankle. This procedure removes diseased or otherwise damaged tissue from a lesion to help it heal faster, make it less painful, and keep it from getting infected.

The benefits of wound debridement include:

• Removal of unviable tissue and foreign material
• Stimulation of healthy tissue growth
• Lower risk of infection
• Decreased healing time
• Reduced pain

What are the complications of wound debridement? 

As with any medical surgery, there is a risk of complications during or after debridement exists. By trusting your care to a highly-trained and specialized wound care surgeon, you can limit your risk of serious complications.

Complications of wound debridement may include:

• Bleeding
• Growth of biofilm and wound infection
• Irritation or allergic reaction
• Healthy tissue damage
• Pain

There may be some unfavorable effects, but in most cases, the advantages are worth it. Debridement is essential for wound bed preparation and healing many foot and ankle wounds, like pressure ulcers, skin grafts, or leg ulcers.

Wound care after debridement 

In most cases, wound healing takes 6-12 weeks. The speed at which the wound heals is proportional to its severity, size, and location. Your type of debridement will also impact your healing time.

You’ll be sent home with aftercare instructions. Following these instructions will decrease your risk of complications and improve your healing speed.

Here are a few things to help with wound management:

• Make sure to swap wound dressings regularly. Hydrocolloids and clear hydrogel dressings help you monitor for signs of infection.
• The dressing needs to stay dry. Do not enter any water, including pools and hot tubs. Get the okay to shower from your doctor.
• Maintain a sanitary environment around the cut. When touching a wound, always make sure to, first and foremost, clean your hands.
• Cushion your wounds with the appropriate equipment. An injury to the foot or ankle may necessitate the use of crutches.
• Even if you think you’re doing better, continue following the directions given by your doctor and attend any necessary follow-up appointments.

Worried about a foot or ankle wound? Contact UFAI’s wound care team

UFAI is nationally recognized for advanced wound care treatment — specializing in wounds of the feet. Our podiatrists have decades of combined experience managing the special circumstances surrounding all types of foot problems and injuries.

As one of Southern California’s largest and oldest podiatric healthcare practices, our wound care center offers multi-disciplinary medical care. With diagnostic testing — including vascular testing — available on-site at our clinics, our patients are saved the time and hassle of running around to different diagnostic centers.

We are conveniently located throughout Southern California, and the Los Angeles area as our foot doctors are available at locations in or near: Santa Monica, Beverly Hills, West Los Angeles, Manhattan Beach, Northridge, Downtown Los Angeles, Westlake Village, Granada Hills, and Valencia, California. We accept over 1000 PPO health insurance plans, including Medicare.

If you want to learn more about how UFAI can help you, we encourage you to schedule a consultation with one of our foot and ankle specialists by calling (877) 736-6001 or making an appointment online.

 

Wound debridement FAQs

 

How often should a wound be debrided?

In-office debridement is often performed every one to two weeks, depending on the type of wound. It’s possible debridement won't be needed more than once; in fact, excessive debridement can harm the healing process.

 

When should you not debride a wound?

Debridement is not the right option when the dead tissue or gangrene is dry and there is no infection — such as with an ischemic diabetic foot. The devitalized tissue should be allowed to dry and slough away.

 

Sources

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Kajagar BM, Godhi AS, Pandit A, Khatri S. Efficacy of low level laser therapy on wound healing in patients with chronic diabetic foot ulcers—a randomised control trial. Ind J Surg. 2012;74:359-363.

Panayiotopoulos YP, Tyrrell MR, Arnold FJ, Korzon-Burakowska A, Amiel SA, Taylor PR. Results and cost analysis of distal [crural/pedal] arterial revascularisation for limb salvage in diabetic and non-diabetic patients. Diabet Med 1997;14:214–220. DOI: 10.1002/(SICI)1096-9136(199703)14:3<214::AID-DIA339>3.0.CO;2-9

Tian X, Liang XM, Song GM, Zhao Y, Yang XL. Maggot debridement therapy for the treatment of diabetic foot ulcers: a meta-analysis. J Wound Care 2013;22:462–469