Overview of wound debridement

Debridement is an important step in preparing the wound bed for healing, and to facilitate dressing efficacy. Debridement describes methods that facilitate removal of necrotic (dead) tissue, metabolic waste, fibrin and foreign material from a wound. Necrotic tissue impairs wound healing by stimulating inflammation and delaying granulation and epithelialisation. Debridement removes senescent cells (that are no longer dividing) from the wound bed and nonmigratory cells from the wound edge. It can help manage infection by removing infected tissue from the wound bed.

Necrotic tissue can be removed using autolytic, sharp, surgical, mechanical (ie hydrosurgical, ultrasound), biological or enzymatic debridement. There is insufficient evidence to conclude that one method of debriding is superior to another. Selective methods of debridement are generally preferred because they only remove necrotic tissue. For some wounds, more than one method of debridement may be appropriate.

The most appropriate debridement method is determined by many factors, including:

  • the patient’s setting (eg in the community compared to in hospital)
  • the patient’s wishes, concerns and medical history
  • the wound (consider pain, pathophysiology, size, depth, position, amount of exudate, the wound tissue, potential for bleeding, risk of infection)
  • the skill and knowledge of the clinician and available resources
  • the cost of the procedure.

Debridement is not indicated in some instances, and sometimes specialist referral may be required; see When not to debride an ulcer or wound. If stable dry eschar (adherent, intact, without erythema or fluctuance) is present, debridement should not be undertaken until arterial flow has been ensured or re-established.

Figure 1. When not to debride an ulcer or wound

Do not debride:

  • stable dry eschar (unless there is adequate perfusion to the area)
  • wounds with an inflammatory pathology (eg pyoderma gangrenosum)
  • wounds with a prosthetic implant (requires specialist surgical assessment)
  • wounds associated with congenital malformation, suspected or confirmed malignancy or if standard anatomy has been altered (requires specialist surgical assessment)
  • lower-limb wounds in patients with arterial disease (requires specialist vascular assessment).

Debride the following with caution (usually performed by a specialist):

  • extensive necrotic tissue
  • wounds on the hands or face
  • wounds with exposed bone.

Practitioners undertaking debridement should ensure they have appropriate competency.