During the healing process of a wound, there may be dead, or necrotic, tissue present as a result of the initial trauma, or because new tissue is delicate and some dies during the healing process. This tissue can be a breeding ground for bacteria and fungus, and can physically interfere with the growth of new, healthy tissue. For this reason, debridement is sometimes necessary.
There are many different ways to debride tissue, but the purpose of all methods is the same – to get rid of necrotic tissue in order to allow healthy tissue to flourish and healing to proceed. Different methods of debridement have pros and cons that should be considered before choosing which one will be used.
Autolytic debridement does not require any interference in the wound – it is a naturally occurring process. The fluid that leaks from open wounds also debrides necrotic tissue safely. All that is required is for a dressing to be placed over the wound to keep the wound fluid in contact with the tissue for short periods of time – usually only a day or two. This process is beneficial because it is completely natural and causes little to no pain, but it is a slow process and wounds must be carefully monitored for signs of infection, as bacteria may breed in the fluid.
The use of chemical enzymes for wound debridement is simple – certain chemicals will dissolve necrotic tissue. Some chemicals are selective and damage only necrotic tissue, but some are not and may destroy healthy tissue, as well. Using chemicals for debridement is generally more successful when the enzymes are applied directly to necrotic tissue only – which means that a medical professional will have to do the application. Selective enzymes may be applied by the patient as precision is not necessary. Solutions traditionally used for this sort of debridement include iodine and hydrogen peroxide. This sort of debridement may or may not be painful to the patient based on the chemical used..
Mechanical debridement can be achieved in several ways; allowing a dressing to become very wet with fluid and then removing it, taking tissue with it, manually scraping tissue with an instrument, and using water or a saline solution to flush tissue from the wound. All forms of mechanical debridement are non-selective, producing a risk that healthy tissue will be removed along with the necrotic tissue. Also, the use of water or a saline solution may introduce waterborne pathogens into the wound, even if every effort is made to keep the solution sterile. Mechanical debridement can also be time consuming and painful to the patient.
Using a sharp surgical instrument or a laser to debride a wound is fast, selective, thorough, and helpful for patients with a lot of necrotic material in their wounds, or a combination of necrotic and infected material. The drawbacks include pain to the patient and a high cost, especially if an operating room is required.
Maggots, used for thousands of years to help heal difficult wounds, are making a comeback. Although maggots may seem unsanitary, and the thought of letting them live in a wound can be shiver-inducing, maggots are actually a very safe and selective method of wound debridement as they will only eat necrotic tissue and not touch healthy live tissue. Maggots are inexpensive, as they can be easily bred, and they are simple to use, as they do all the work. The only drawback is the inevitable squeamishness they inspire.
There are many different options for wound debridement in order to speed healing, and the appropriate choice should be discussed with your medical care provider.