Debridement of a Wound, Infection, or Burn
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Debridement of a Wound, Infection, or Burn

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Definition

Surgical, chemical, mechanical, or autolytic (using the body's own processes) removal of wound or burn tissue to promote healing.

Surgical Debridement of Lower Leg Wound

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Parts of the Body Involved

Skin and in some cases, fascia, muscle, or supportive tissue below the surface.

Reasons for Procedure

Debridement is used to clean dead and contaminated material from a wound to aid in healing, increase the tissue's ability to resist infection, and decrease inflammation. It can also be performed to get a tissue sample for testing and diagnosis. The procedure is most often performed for the following reasons:

  • To remove tissue contaminated by bacteria, foreign tissue, dead cells, or a crust
  • To create a neat wound edge to decrease scarring
  • To aid in healing very severe burns or pressure sores (decubitus ulcers)

Risk Factors for Complications During the Procedure

  • Bleeding
  • Infection
  • Pre-existing medical conditions
  • Smoking
  • Diabetes
  • Use of steroid or other immunosuppressive medications
  • Poor nutrition
  • Poor circulation
  • Immune disorders

What to Expect

Prior to Procedure

Your doctor will likely do the following:

  • Physical exam
  • Measurement of the wound
  • Provide pain medication before changing debridement dressings (for nonsurgical procedures)

In the days leading up to your procedure:

  • Arrange for a ride to and from the procedure
  • The night before, eat a light meal and do not eat or drink anything after midnight

During Procedure

Possibly IV fluids and sedation during surgical procedure

Anesthesia

Local or general anesthesia may be used when surgically debriding deep pressure ulcers or other wounds. Anesthesia usually is not given for other methods.

Description of the Procedure

The following four methods are frequently used in conjunction with one another:

Surgical Debridement

If your wound is characterized by large, deep tissue damage and/or is especially painful, or if debriding your wound is urgent, surgical debridement will be done using scalpels, forceps, scissors, and other instruments. The skin surrounding the wound is cleaned and disinfected, and the wound is probed with a metal instrument to determine its depth and locate any foreign matter. The doctor cuts away dead tissue, then washes out any remaining, free tissue. The resulting edge is smooth and usually runs from one end of the wound to the other. In some cases, transplanted skin may be grafted into place. Sometimes, cutting away the entire contaminated wound may be the most effective treatment.

Chemical Debridement

The healthcare provider applies debriding medication to the wound and covers with a dressing. The enzymes dissolve the necrotic tissue of the wound.

Mechanical Debridement

Methods include whirlpool baths, use of syringe and catheter, or wet to dry dressings to remove dead or infected tissue. The wet to dry procedure involves applying a wet dressing to the wound. As this dressing dries, it absorbs wound material. When the dressing is remoistened and removed, some of the tissue comes with it.

Autolytic Debridement

If quickly debriding your wound is not essential, if your wound is not infected, and/or if your body cannot tolerate the more forceful treatments, autolytic debridement may be done. Dressings that retain wound fluids (hydrocolloid, hydrogel, and transparent film) can facilitate the body's natural abilities to clean the wound. This type of dressing is often used to treat pressure sores.

Biodebridement

One example is maggot therapy The medical benefits are acknowledged by the US Food and Drug Administration (FDA) and other scientific organizations. The procedure involved using sterile fly maggots to break down or ingest infected or necrotic tissue. The maggots do not damage healthy tissue. The bacteria in the wound is eliminated, which reduces odor and allows the wound to heal more quickly.

After Procedure

Possibly laboratory examination or culture of removed tissue may be done.

How Long Will It Take?

This depends on the type of debridement. Surgical debridement is the quickest method; nonsurgical debridement may take 2 to 6 weeks or longer.

Will It Hurt?

During a surgical debridement, general anesthesia prevents pain during the procedure. If a local anesthetic or sedative is given, some patients report discomfort or apprehension during the procedure.

Mechanical debridement and chemical debridement often produce pain. Pain medication can be given before changing the dressing to help relieve the discomfort.

Possible Complications

  • Pain
  • Bleeding
  • Infection
  • Delayed healing
  • Removal of healthy tissue with mechanical debridement

Average Hospital Stay

None

Postoperative Care

  • Follow your doctor's directions for wound care. If you are unsure about any aspect or unable to perform the care, discuss your concerns with your doctor.
  • Keep the wound and dressings clean and dry.
  • Take medications as ordered and do not stop medications early, even if the wound starts to look better.

Outcome

It may take the wound many weeks to heal. A specific wound-care program will be suggested to speed your recovery.

Call Your Doctor If Any of the Following Occurs

  • Redness, swelling, increasing pain, excessive bleeding, or discharge at the wound site
  • Chalky white, blue, or black appearance to tissue around wound
  • Signs of infection, including fever and chills
  • Following surgical procedures with general anesthesia: cough, shortness of breath, chest pain, or severe nausea or vomiting

RESOURCES:

Visiting Nurse Associations of America
http://www.vnaa.org/vnaa

Wound Ostomy and Continence Nurses Society
http://www.wocn.org

CANADIAN RESOURCES:

Canadian Association of Wound Care
http://www.cawc.net/open/wcc/index.html

Shriners Hospital for Kids
www.shrinershq.org

References:

Clinical Procedures in Emergency Medicine . 3rd ed. Philadelphia, PA: WB Saunders Co.; 1998.

Debridement. Visiting Nurse Associations of America website. Available at: http://www.vnaa.org/vnaa/g/?h=html/wound_center_oct . Accessed October 20, 2005.

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 Jun;3(2):223-7.

Rakel RE, Bope ET. Conn's Current Therapy 2001 . 53rd ed. Philadelphia, PA: WB Saunders Company; 2001.

Spires MC. Frontera: Essentials of Physical Medicine and Rehabilitation, 1st ed. Philadelphia; Hanley and Belfus; 2002. Ch. 96.

Steed DL. Debridement. American Journal of Surgery. 2004;187(5) Suppl 1.



Last reviewed December 2007 by John C. Keel, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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