‘Out wound. The extent of surgical debridement ranges

‘Out with the old, and in with the new!’ – this is exactly what happens in a common technique used to assist in wound healing known as debridement. Discover more about the fascinating types of debridement available to patients in this lesson.

What Is Debridement of a Wound?

Debridement is the removal of dead or infected tissue from a wound in order to allow healthy new tissue to form, filling in the wound.So you may be thinking, ‘Seriously, digging at a wound that is trying to heal will actually help?’ It may seem counter-intuitive, but YES! Actually the removal of all that waste helps speed the healing process, by enabling the skin’s own regenerative powers to focus on quickly laying down a new layer of skin.Let’s think of the formation of a new road.

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The old one is all beat up: filled with potholes and cracks of varying sizes with chunks of old asphalt littering the road. How would you achieve the smoothest new road most quickly? By actually ripping up the old road, getting down to a fresh dirt foundation, and then pouring asphalt evenly to form the new road. Think of how long it would take to pick up all the little asphalt bits, fill in each separate defect, and then try to make sure the entire thing was even! So it is with our skin. If we remove the entire ‘old road’ it allows the body to get on better and more quickly with building the new one.

This wound has been fully debrided. There is no evidence of necrotic tissue. Only reddish, pink healthy growing tissue, known as granulation tissue, is present.

Wound after debridement.

Types of Debridement

Now, there are many methods for ‘removing the old road’ when it comes to wound debridement. Some methods are more appropriate depending on the type of wound and/or the status of the patient. Below the most common approaches are detailed.

1.Autolytic DebridementIn medical terminology, lytic means to ‘rupture,’ and auto means ‘self-induced.’ Therefore, autolytic debridement translates to letting the body do its own clean-up of dead cells in the wound. This is achieved when the wound is covered with special dressings that absorb the by-products of cell breakdown, known as exudate. This form of debridement tends to achieve results slowly.2. Surgical DebridementIn this type of debridement, surgical instruments are used to forcibly remove dead or infected tissue from a wound.

The extent of surgical debridement ranges widely. In some cases, a patient will only need local anesthesia directly around the wound and a curette will be used to scoop out dead tissue. In other cases, a patient will need to be totally put to sleep (using general anesthesia) and many tools, including scalpels, scissors and forceps, will need to be used. Then the wound is surgically cleaned. This form of debridement is fast and thorough.

Curettes, like these, are used in surgical debridement to scoop dead tissue away from healthy, viable tissue in the base of the wound bed.
Curettes used in surgical debridement.

3.

Mechanical DebridementThis type of debridement includes a plethora of methods, all of which use mechanical force to remove the necrotic (dead) or infected tissue from the wound. Pressurized irrigation uses sterile water at high speeds to rinse the slough from the wound. Wet-to-dry dressings are also a long standing mechanical debridement technique. A wet dressing is applied to the wound and then allowed to dry. The dressing (usually after being remoistened) is then removed, bringing the dead tissue with it. Low frequency mist ultrasound, vacuum assisted closing devices and whirlpool baths are other methods of mechanical debridement.

This Wound V.A.C. device utilizes negative pressure to debride and help close wounds. It is especially effective on pressure sores.

Wound VAC device

4. Biosurgical DebridementNow, brace yourself, this type of debridement utilizes maggots. As gross as this may seem, these creatures have been in use for hundreds of years to promote wound healing.

Maggots effectively eat dead or infected tissue, while sparing healthy tissue. Furthermore they excrete antibacterial chemicals that help prevent or remedy infection. Lastly, the maggots work quickly, only needing 3 to 5 days on average to accomplish the job.

Wound Assessment

Often the wound chooses the type of debridement that is needed.

If a severe infection is present, this necessitates a fast, thorough method that ensures removal of all affected tissue, such as surgical debridement. Biosurgical debridement may be utilized if rapid treatment is necessary, but the patient is not stable enough for surgery. If the patient’s wound has minimal dead tissue and no signs of infection, then autolytic debridement would be appropriate.

Lesson Summary

Debridement is the process by which dead (necrotic) or infected tissue is removed from a wound bed, allowing healthy tissue to continue to fill in the defect. There are 4 commonly used types of debridement: autolytic, surgical, mechanical, and biosurgical.Autolytic methods promote the body’s own natural ability to clear the wound bed of dead tissue by using special absorptive dressings.

Surgical debridement uses surgical instruments to physically cut away the necrotic, infected tissue. Mechanical debridement encompasses forceful removal methods of dead tissue, including wet-to-dry dressings, vacuum wound closure and whirlpools. Lastly, the use of maggots represents Mother Nature’s form of debridement, known as biosurgical debridement. Each method has its own advantages, and sometimes certain wounds must be treated with more than one method before complete debridement is accomplished.Medical Disclaimer: The information on this site is for your information only and is not a substitute for professional medical advice.

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