Debridement of a Wound, Infection, or BurnEditorial Staff And Contributors DefinitionDebridement is the removal of unhealthy tissue from a wound to promote healing. It can be done by surgical, chemical, mechanical, or autolytic (using your body's own processes) removal of the tissue. Surgical Debridement of Lower Leg Wound Copyright © Nucleus Medical Media, Inc. Reasons for ProcedureDebridement is used to clean dead and contaminated material from your wound to aid in healing. The procedure is most often done for the following reasons:
Possible ComplicationsComplications are rare, but no procedure is completely free of risk. If you are having a debridement, your doctor will review a list of possible complications, which may include:
Factors that may increase the risk of complications include: What to ExpectPrior to ProcedureYour doctor will likely do the following:
Arrange for a ride to and from the procedure If you will be getting general anesthesia, do not eat or drink anything after midnight the night before the procedure AnesthesiaAnesthesia may be used for deep pressure ulcers or other wounds. Local anesthesia will numb the area. General anesthesia will allow you to sleep through the procedure. Description of ProcedureThe following four methods are often used in combination: Surgical DebridementSurgical debridement is done using scalpels, forceps, scissors, and other instruments. It is used if your wound is large, has deep tissue damage, or if your wound is especially painful. It may also be done if debriding your wound is urgent. The skin surrounding the wound will be cleaned and disinfected. The wound will be probed with a metal instrument to determine its depth and locate any foreign matter. The doctor will cut away dead tissue. The wound will be washed out to remove any free tissue. In some cases, transplanted skin may be grafted into place. Sometimes, cutting away the entire contaminated wound may be the most effective treatment. Chemical DebridementA debriding medicine will be applied to your wound. The wound will be covered with a dressing. The enzymes in the medicine will dissolve the dead tissue in the wound. Mechanical DebridementMechanical debridement can involve a variety of methods to remove dead or infected tissue. It may include using a whirlpool bath, a syringe and catheter, or wet to dry dressings. Wet to dry dressing starts by applying a wet dressing to your wound. As this dressing dries, it absorbs wound material. The dressing is then remoistened and removed. Some of the tissue comes with it. Autolytic DebridementThis form of debridement uses dressings that retain wound fluids that assist your body's natural abilities to clean the wound. This type of dressing is often used to treat pressure sores. This process takes more time than other methods. It will not be used for wounds that are infected or if quick treatment is needed. It is a good treatment if your body cannot tolerate more forceful treatments. Immediately After ProcedureSamples of the removed tissue may be sent to a lab for examination. How Long Will It Take?The length of treatment depends on the type of debridement. Surgical debridement is the quickest method. Nonsurgical debridement may take 2-6 weeks or longer. How Much Will It Hurt?During a surgical debridement, general anesthesia prevents pain during the procedure. When local anesthetic or sedative is given, some patients report discomfort. Often, patients will be sore while recovering from the procedure. Pain medicines may be given to help relieve pain. Mechanical debridement and chemical debridement often cause pain. Pain medicine can be given before changing the dressing to help manage pain. Average Hospital StayDepending on the reason for the debridement, you may be able to go home on the same day. If you are already in the hospital, this procedure should not extend your stay. Post-procedure CareAt HomeIt may take the wound many weeks to heal. A specific wound-care program will be suggested to speed your recovery.
Call Your DoctorAfter you leave the hospital, contact your doctor if any of the following occur:
In case of an emergency, call for medical help right away. Visiting Nurse Associations of America Wound Ostomy and Continence Nurses Society Canadian Association of Wound Care Health Canada Debridement. Visiting Nurse Associations of America website. Available at: http://vnaa.org. Accessed October 20, 2005. Golinko MS. Operative debridement of diabetic foot ulcers. J Am Coll Surg. 2008;207 (e1-6). Nigam Y, Bexfield A, Thomas S, Ratcliffe NA. Maggot therapy: the science and implication for CAM part I-history and bacterial resistance. Evid Based Complement Alternat Med. 2006;3:223-227. Rakel RE, Bope ET. Conn's Current Therapy 2009. 1st ed. Philadelphia, PA: WB Saunders Company; 2008. Roberts JR. Clinical Procedures in Emergency Medicine. 3rd ed. Philadelphia, PA: WB Saunders Co; 1998. Spires MC. Frontera: Essentials of Physical Medicine and Rehabilitation. Philadelphia, PA: Hanley and Belfus; 2002: chap 96. Steed DL. Debridement. American Journal of Surgery. 2004;187(suppl 1). Wong CH. Approach to debridement in necrotizing fasciitis. American Journal of Surgery. 2008; 196 (e19-24). Last reviewed October 2012 by Peter Lucas, MD |
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