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WOUND DEBRIDEMENT
Wound debridement is a key
componednt of wound bed
preparation (Wilcox et al, 2013). It
involves the removal of damaged
and dead tissue, debris and bacteria
from the wound bed (Brown, 2013),
which reduces the risk of infection
and encourages wound healing by
allowing healthy granulation tissue
to form.
In acute wounds, autolytic
debridement occurs automatically
and often does not require
intervention (Atkin, 2014), as
during the inflammatory stage of
wound healing, neutrophils and
macrophages digest and remove
non-viable tissue, cell debris and any
cellular barriers to wound healing.
However, in chronic wounds, this
process can become overwhelmed
and inefficient (Broadus, 2013).
Wound debridement is thus an
essential part of chronic wound
management, as it assists the
conversion of the molecular and
cellular environment to resemble that
of an acute wound and encourages
wounds to progress to healing (Ousey
et al, 2016).
Beverley Edmunds, community staff nurse,
Friar Park district nurses
Wound debridement in the community
IN BRIEF
Debridement is a key component of wound bed preparation.
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KEYWORDS:
Wound bed preparation
Debridement
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Skin care
Beverley Edmunds
10 JCN supplement
2018,Vol 32, No 4
WHEN TO DEBRIDE
Before debriding, comprehensive
holistic wound assessment and
diagnosis is essential to ensure that
it is suitable (Vowden andVowden,
2011). There will be situations
where a patient’s comorbidities or
underlying arterial status may mean
that debridement is contraindicated.
For example, necrotic tissue in lower
limb wounds in cases of dry gangrene
and arterial insufficiency should,
where safe to do so, be left to auto
debride. Once a decision to debride
a wound has been made, there are
multiple methods to choose from,
such as:
`
Autolytic
`
Biosurgical
`
Enzymatic
`
Hydrosurgery
`
Mechanical/physical
`
Sharp/surgical.
Method chosen will be dependent
on many factors, such as:
`
Clinician skill
`
Location of wound
`
Treatment environment
`
Equipment available
`
Patient choice.
Mechanical debridement involves
using an external force to separate
necrotic tissue from the wound bed.
Historically, this was carried out with
wet dressings, such as gauze, which
were left to dry and then regularly
changed. This mechanically removed
i
Practice point
Ongoing, regular debridement is
vital to maintain a healthy wound
bed in most chronic wounds
(Wolcott et al, 2009).
devitalised tissues but could also strip
healthy tissue away. This method is
no longer common practice in the UK
(Davies, 2004), and newer products
have been developed to assist with
mechanical debridement.
For example, mechanical
debridement can be carried out
with a pre-moistened debridement
cloth (UCS
™
, medi UK). This has
been found to be fast, simple and
effective and requires no specialist
training (Hughes, 2015). The UCS
pre-moistened debridement and
cleansing cloth allows for atraumatic
cleansing and debridement of a
wound and the surrounding skin
without the use of extra water,
surfactants or equipment (Downe,
2014). Debridement in this form is so
simple that it can also be undertaken
by patients themselves, thereby
enabling and promoting self-care.
UCS
™
premoistened
debridement cloths
The cloth works by gently lifting and
removing barriers to healing, such as
slough, debris and biofilm, which are
trapped in the cloth’s specially woven