Debridement

Debridement

A wound is an injury that refers to a localized defect or excavation of the skin. When wounds are open in our bodies, there are chances for pathogenic organisms to invade the tissue surrounding the wound and contaminate it. The contaminated tissue, when left in the wound, will trigger the body’s immune response and cause inflammation and tissue damage, thereby delaying the healing process. In some cases, the contaminated tissue will cause various infections and lead to tissue necrosis. This can sometimes progress to a life-threatening condition. When there is non-viable tissue and necrosis, a doctor may perform wound debridement to remove the contaminated and necrotic tissue, promote wound healing, and prevent the progression of infection.

What is debridement?

Debridement is the process of removing unhealthy tissue from a wound associated with injuries or other diseases. It is a crucial stage in the healing of a wound. It involves cleaning the wound, and removing the thickened skin (hyperkeratotic tissues), dead or necrotic tissues, foreign particles, and other residual particles in the wound. The debridement process also treats pockets of pus called abscesses, which can develop into sepsis.

Bone debridement is an important process when dealing with unviable and avascular tissue; these have a tendency to fester infections and delay healing.

Debridement can be carried out using a variety of methods, such as:

• Surgical debridement: It is also known as sharp debridement, where a surgeon will remove the dead tissues using a sharp instrument like a scalpel or special scissors. Hyperkeratotic, infected, and necrotic tissues are removed in this procedure. It is the most aggressive type of debridement and is performed in an operating room using anesthesia.
• Autolytic debridement: In this method, the body will remove the unhealthy tissue on its own with the aid of a proper dressing or wound care. This method uses the body's healing enzymes to rehydrate and soften the non-viable or necrotic tissues. Hydrocolloids, hydrogels, and clear films are the dressing components employed in this technique. It moves the most slowly.
• Mechanical debridement: It is the most common type of debridement and is carried out by irrigation, pulsatile lavage, and wet-to-dry dressings.
  • A catheter tube and syringe are used during wound irrigation to remove dead tissue.
  • Pulsatile lavage uses water to remove the necrotic cells and residual particles in the wounded area.
  • A wet-to-dry dressing uses moist gauze on the wound that requires debridement and is allowed to dry and adhere to the tissue in the wound bed. Once the gauze is completely dried, the necrotic tissues adhered to the dressing will be removed. This type of dressing needs to be changed daily, and it is accepted as long-term care.
• Enzymatic debridement: This method uses chemical enzymes in the form of solutions or ointments, along with wound dressing and care, to treat the unhealthy tissues. These enzymes, which will eliminate the necrotic tissues, are obtained from microbes like Clostridium. Enzymatic debridement is planned for a long-term care setting, as it should be performed daily for better results.
• Biological debridement: This method is also called maggot therapy, where it uses maggots (Luciliasericata, the green bottle fly) to digest the dead tissue and pathogens in the wound. The sterile maggots are placed on the wound bed along with the dressing; the maggots will eat only the dead skin and produce chemicals that promote healing.

Why is debridement necessary?

Debridement is not necessary for all wounds. The procedure is essential for wounds that are infected and not healing. It is recommended when:

• New tissues cannot grow in the injured site due to dead tissues, which prolongs the process of healing.
• Dead tissues have pockets of pus.
• Dead tissues trap bacteria that cause wound infections and a bad odor.
• Tissue samples are needed from the injured site for testing.

Bone debridement is recommended for:

• Slow-healing wounds associated with exposed bone
• Osteomyelitis patients, who have an infection in the damaged bone
• Bone-related benign lesions
• Patients with diabetes who have open sores on their limbs are at heightened risk of infection.

How do I prepare for this procedure?

The wound debridement procedure is carried out on an outpatient basis, so you can go home the same day of the procedure.

Your doctor will perform a physical exam and take measurements of the wound to finalize the debridement method.

In the case of a surgical debridement, your doctor will inquire of you:

• The night before the surgery, as eating or drinking could increase the risk of issues like nausea or vomiting while delivering anesthetic. Either local or general anesthesia will be administered to numb the area being worked on. General anesthesia blocks sensation and renders the patient unconscious.
• Must make arrangements for a ride home after the surgery.

Before using any other non-surgical techniques, oral painkillers are administered.

What takes place throughout the process?

The methods for debridement vary according to the kind of wound or injury you have and how serious it is. The following are the common surgical and non-surgical debridement techniques:

Surgical method

• The patient will be shifted to the operating room, and then the anesthesiologist will administer the anesthesia.
• A surgeon will remove dead or unhealthy tissues and foreign bodies if they are present using sharp instruments like a scalpel or scissors.
• A surgical dressing is then applied after controlling the bleeding.
• In some cases, surgical debridement may be followed by skin grafting, where a layer of skin from some other part of the patient's body will be removed and placed on the wounded area.

Non-surgical method

The procedure will be carried out either in the doctor's office or the patient's room.

• In the non-surgical method, the doctor may use chemical enzymes, saline water, or syringes to brush away the dead skin.
• Once the dead skin and cell debris are removed, the wound will be dressed well for faster wound healing.

The non-surgical method requires frequent hospital visits, as the wound dressing should be repeated several times for better results.

What are the post-procedure care?

Once the procedure is carried out, the tissue samples will be sent to the laboratory for examination.

If you have undergone a surgical debridement, you will be shifted to the recovery room until the effects of anesthesia wear off. You may experience pain and swelling once you regain consciousness after the procedure. Medications are prescribed to ease the pain. Before you go home, your doctor will give you instructions on how to take care of your wound.

A nonsurgical debridement procedure may take 2-6 weeks or longer. You will be given oral pain medications to ease the post-procedure pain. You will be instructed about taking care of the wound at home along with the hospital visit schedule.

Wound care: Its important to take care of your wound for fast healing and to avoid the risk of complications after the procedure. Instructions for wound care after the debridement are:

• Change the dressing daily or according to the doctor's instructions.
• Keep the dressing dry to avoid infection.
• Avoid touching your wound frequently, and try to keep the wound clean.
• Avoid applying pressure to the wounded area. Use crutches if your wound is on your leg or foot.

In most cases, the recovery takes six to twelve weeks. It depends on the severity, size, and location of the wound and the debridement method.

Outlook

Debridement is a critical step in the recovery process. Not all wounds need debridement. The process is necessary when the wound is not getting better. It will promote wound healing, reduce the chance of infection, and improve patient outcomes. Bone debridement is a successful treatment method for the treatment of osteomyelitis. Practicing good wound care along with proper rehabilitation will help your wound heal properly. Debridement offers high patient comfort, lowers risks, and produces optimal results.