Selective Methods Of Debridement
What is debridement?
Debridement is the removal of foreign bodies, necrotic (dead) tissues, and poorly healing tissues from a wound. It is usually done to help a wound begin to heal. It is also done to check for infection or unwanted tunnels under the skin. Bone and other deep tissue infections may also be found when doing debridement. With debridement, dead tissues, and sometimes even normal healthy tissues, are removed slowly and little by little from the wound. As the healing process starts and the wound improves, you may need to return for more wound debridement. In severe (very bad) cases, wounds may take years to show improvement and healing, or may not even heal at all.
Why is wound debridement needed?
Wound debridement is needed when certain factors, such as foreign bodies and dead tissues, delay the healing process. These factors may also cause the wound to be infected with germs, and healing may take even longer. Removing tissues or foreign body materials lets caregivers look more closely at your wound. This helps them plan the best treatment for the wound.
What are selective methods of wound debridement?
Selective methods of wound debridement remove only the necrotic and poorly healing tissues. Your caregiver may use any of the following:
- Autolytic method: This method uses the body's own wound fluid to separate the necrotic from healthy tissues. The wound is covered with bandages which will keep the wound bed moist. The proteins in the wound fluid will change dead and hard tissue into liquid. The wound must then be washed to remove the liquefied tissue debris (waste). This method is safe, easy to do, and has lower risk of wound infection than some other methods. This method is used when surgery is not possible.
- Biosurgery: This is also called a maggot debridement method. The method uses sterile (clean) maggot larvae which release enzymes (special chemicals) that break down the dead tissue. The larvae digest bacteria in the wound, and the enzymes prevent new bacteria from growing on the wound. It may be used on persons of all ages and in pregnant women, but cannot be used in people who have certain allergies. This method is used most often on wounds caused by pressure, diabetes, and ulcers caused by poor blood flow. It is also used for wounds caused by trauma, surgery, and burns.
- Enzymatic method: This uses protein enzymatic agents (medicines) that work by digesting and melting dead tissue. This method is used in people who cannot have surgery. These enzymes are used with antibiotic medicine to help wounds heal.
- Hypobaric method: This method uses a foam bandage and a suction tube on the cleaned wound. It is sealed with a clear, see through bandage to create suction on the wound. The suction pulls cells closer together and forces them to multiply faster, causing new tissues to grow. This helps healing to begin. The suction pulls out and removes dead tissues and extra fluids.
- Surgical method: This method is the quickest and best way to remove dead tissues. It is done in large wounds, severely infected wounds, or wounds that need infected bone and tissue removed. Sharp surgical tools, such as a scalpel (knife), forceps, and scissors are used. This method is chosen if wound debridement is needed quickly.
- Others: The use of laser to remove the dead tissue decreases swelling and may start wound healing. Using honey medicine placed through special bandages takes away dead tissue by action of the sugar content. It also removes the bad odor of the wound, and may be less painful than other methods. It may be used on all types of wounds especially on chronic (long term) ulcers and burns.
What factors decrease the ability of my wound to heal?
- Age: Young people have more elastic skin and stronger connective tissues. These factors allow skin to heal faster. Elderly people have loose skin, decreased fat, and weak collagen (protein that strengthens tissues) which makes their skin easily damaged.
- Chronic disease: This includes diseases, such as diabetes (high levels of sugar in the blood) and atherosclerosis (blocked arteries). These conditions cause less blood flow to the arms or legs. Poor blood flow carries less oxygen and nutrients to wounds, causing them to heal slowly.
- Medicines: Medicines used for treating inflammation (swelling) may delay healing by decreasing the immune (defense) system of the body. Steroid medicines block the natural process of carrying white blood cells to wounds. White blood cells help wounds heal. People who use steroids are also at higher risk of wound infection. Long-term use of antibiotics increases your risk of super infection. If you have a super infection, stronger and larger amounts of antibiotics are needed to treat it.
What can I do to help my wound heal?
Wound protection, a moist wound, and enough oxygen helps wounds heal faster. Do the following to help your wound heal:
- Avoid smoking: Smoking cigars, pipes and cigarettes may decrease the ability of new blood vessels to form on the wound site. It may also decrease the action of hemoglobin (part of the blood carrying oxygen) and delay healing.
- Avoid stress: Stress causes the blood vessels to constrict (get small). This may lead to less oxygen supply to the tissues and delay healing.
- Drink enough liquid: Men 19 years old and older should drink about 3.0 Liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). Follow your caregiver's advice if you must change the amount of liquid you drink. For most people, healthy liquids to drink are water, juices, and milk. Drinking enough liquids keeps wounds moist, helping them heal faster.
- Eat a healthy diet: Foods rich in protein, such as meat, eggs and dairy products, help repair tissue. Carbohydrate-rich foods, such as bread and cereals, are needed for cell growth, and help decrease wound infection. Eating more calories, and foods rich in zinc, such as meats, seafood (especially oysters), and liver, may also help healing. Taking vitamins A and C help collagen formation and increase scar tissue strength. Caffeine causes blood vessels to constrict (get small). This results in less oxygen getting to tissues, and delays healing. Caffeine may be found in coffee, tea, soda, and sports foods and drinks. Ask your caregiver for more information about foods that may help wound healing.
- Exercise regularly: Regular exercise improves blood flow to the body. This causes more oxygen to go to body cells. When cells have enough oxygen, wounds heal faster.
What are the risks of having wound debridement?
- Surgery and the use of lasers may damage healthy tissues, or cut blood vessels. You may bleed more than expected or get an infection. You may be allergic to anesthesia medicine. Using larvae of maggots may be uncomfortable. High negative pressure may be painful. Other methods may not heal wounds if they are used only once, and may need to be many times. You may worry about the wound which may get bigger after it is debrided.
- If you choose not to have your wound debrided, your wound may not start to heal for a long time. The longer you have your wound, the higher you risk for infection and tissue damage. The pain or other symptoms that you have may worsen. Contact your caregiver if you have concerns or questions about your wound, medicine or care.
Care AgreementYou have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.
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