Wound Debridement

Abstract

Introduction The word debridement first came from the French desbrider, meaning, “to unbridle.” It was probably first used as a medical term by surgeons working several hundred years ago in war zones, who recognized that grossly contaminated soft-tissue wounds had a better chance of healing if the affected tissue was surgically removed. Wound debridement has evolved and is now recognized as a key component of preparing a wound bed for healing. The presence of necrotic or devitalized tissue on the surface of a wound prevents accurate assessment of the extent of tissue destruction, inhibiting clinicians’ abilities to correctly stage or classify wounds using standard assessment tools. During the normal cascade of events leading to wound repair, inflammatory cells, such as neutrophils and macrophages, are activated to remove devitalized tissue, participate in antimicrobial defense, and facilitate the beginning of the repair process. The alteration in this and subsequent cellular activities creates an environment leading to wound chronicity and, ultimately, a milieu of increasing necrotic burden. The term necrotic burden has been frequently used to describe dead or devitalized tissue, excess exudate, and high levels of bacteria found on the surface of many chronic, nonhealing wounds. In addition to the evident nonviable tissue, resident cells, such as fibroblasts and keratinocytes, may be phenotypically altered and no longer responsive to certain signals, including growth factors. This state is described by the term cellular senescence.7,8 Objectives The reader will be challenged to: • Discuss the contribution that debridement makes to woundbed preparation • Distinguish the types of debridement used in wound-care practices today • Differentiate selective from nonselective debridement • Analyze who would and would not be candidates for debridement in your clinical practice.