Wound Debridement

Wound debridement is a procedure to remove dead, devitalized, or contaminated tissue as well as foreign substances from a wound. A wound must be clean and receive a good supply of blood to heal. Dead tissue, scar tissue, and debris from outside the body can interfere with this. Wounds that are not cleaned heal slowly or not at all and can become infected. The infection can then spread to nearby areas or other parts of the body through the blood. There are a number of methods used for wound debridement: surgical or sharp, autolytic, enzymatic, mechanical, and biosurgery. The method used will depend on the size, position, and type of wound as well as the risk of infection and level of pain. Your doctor will decide which method is most appropriate for your condition. In some cases, more than one method may be used.

  • To promote wound healing by removing all the devitalized tissue from the wound.
  • To protect or reduce risk of infection

For most methods of debridement, no special preparation is required. If general anesthesia will be used, you may need to undergo a check-up as well as blood tests, chest x-ray, and electrocardiogram (EKG) to ensure you are healthy enough for the procedure, and you will have to avoid food and water for 6-8 hours before the procedure. Always let your doctor know if you are taking any medication as some may interfere with the treatment.

1.   Surgical or sharp debridement involves using scalpels, curettes, or scissors to cut away dead, devitalized, or contaminated tissue. It is the fastest way to debride a wound, but it is also the most painful, thus requiring the use of local or general anesthesia. It also requires a skilled doctor. It can be done on most wounds and can be done selectively, minimizing impact to nearby tissue and organs. This type of debridement carries the risk of bleeding and infection as well as loss of tissue.

2.   Autolytic debridement involves using the body’s own enzymes and moisture to re-hydrate, soften, and finally liquefy hardened dead tissue. Wound dressings that maintain a moist wound bed are used to create an optimal environment for this process. This method is easy to perform, does not damage healthy tissue, and causes minimal pain. Healing takes weeks to months.

3.   Enzymatic debridement is the most selective method of wound debridement. It involves applying naturally occurring enzymes that are manufactured to the wound to work alongside the body’s own enzymes. (Debriding agents available nowadays include bacterial collagenase, papain/urea, and fibrinolysin/ deoxyribonuclease (DNAse). This method can irritate surrounding tissue and is slow to work, but is easy to carry out and may be used in combination with other methods.

4.   Mechanical debridement involves physically removing dead tissue and debris from the wound. One way is by using wet-to-dry dressings. A moist dressing is placed over the wound. When it is dry it is lifted off, taking away dead tissue with it. Other methods include flushing the wound with sterile solution, whirlpool baths for powered irrigate to loosen and remove dead tissue and debris, and high-pressure water applied directly to the wound. Some of these can be painful and drive bacteria into soft tissue as well as injure surrounding tissue. This method is not recommended for fragile tissue. It is easy to perform and works faster than autolytic debridement, but can still take some time.

5.   Biosurgery or maggot therapy involves placing a number of small maggots, usually the larvae of the green bottle fly, on the wound so they consume the dead tissue. This method is more precise than surgical debridement. This method takes a day or two. Some patients complain of increased pain after the procedure and the psychological effects of the method must also be considered.

Depending on the type of debridement, you may be able to return home after the procedure or will need to stay in the hospital for some length of time. You will be given instructions on how to care for your wound at home and what level of activity is appropriate for you while debridement is taking place or after it is completed. Always keep all scheduled appointments with your doctor to prevent complications and ensure proper healing.

Risks vary with the type of procedure, but may include uncontrollable bleeding, infection, damage to nerves, blood vessels, or healthy tissue inside and around the wound, pain, and inadequate or lack of healing. If one method of debridement fails, the doctor may need to try another. Please discuss possible risks and complications with your doctor.

·       If you are taking any blood-thinning medication/anticoagulant, please let your doctor know as some may need to be stopped before you travel for the procedure.

·       Travelers to Thailand should plan to stay in the country for at least one week or, depending on their condition after the procedure, for the entire duration of treatment.

·       If you plan to return home after the procedure, please speak to your doctor before making travel arrangements.

·       During your follow-up appointment your medical team will assess your health and your incision and you will receive documents detailing your medical and treatment history and your "Fit to Fly" certificate (if needed).

The success of the procedure depends on a number of factors. Please discuss the likelihood of success with your doctor before the procedure.


What if this procedure is not performed?

If a wound is not cleaned of dead tissue and/or foreign substances, it will not heal or heal badly or become infected. All of these can lead to complications, including pain, infection in other areas of the body, and even sepsis, which is an infection of the blood. If your condition worsens, it can become life-threatening.

A wound must be debrided one way or another for it to heal. Please consult with your doctor.

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