Pearls for Practice: Non-traumatic Wound Debridement

     Wound debridement is a vital function in wound healing. Chronic wounds may have decreased cellular activity, increased amounts of protease activity, and may stall in various stages of wound healing. As a result, debridement is necessary to convert a chronic into an acute wound by removing metalloproteases (MMPs) and stimulating cell activity.

Because they are relatively pain-free, non-traumatic debridement approaches can result in improved patient cooperation with their wound care regimen. Several selective debridement methods can effectively eliminate wound trauma. Autolytic debridement allows the body's own wound fluid to selectively remove necrotic tissue. The wound fluid contains collagenase, macrophages, and neutrophils that are beneficial in the removal of nonviable tissue. To facilitate autolytic debridement, a moist wound environment is created by using an occlusive dressing such as a hydrocolloid, transparent dressing, foam, polymeric membrane dressing, or calcium alginate over the wound bed. The moisture from the wound exudate will dissolve and liquify the nonviable tissue, creating a healthier wound bed.

     Enzymatic debridement uses proteolytic enzymes to digest necrotic tissue. The method can be enhanced in a low-exudating wound by applying a moistened dressing directly over the enzyme to facilitate the moist wound environment required to remove necrotic tissue.

     Biosurgery (maggot therapy) although controversial, is becoming more popular. The larvae liquefy only necrotic tissue while their antimicrobial secretions destroy bacteria (Staphylococcus, Streptococcus, Pseudomonas, and methicillin-resistant Staphylococcus aureus [MRSA]). One or more applications may be required for successful debridement.

     All non-traumatic debridements require dressings appropriate to the wound characteristics. Size, exudate amount, depth, available moisture to the wound bed, bacterial bioburden, and dressing change frequency all should be considered before choosing a debridement method. Heavily draining wounds or the presence of significant bioburden may indicate a need for an antimicrobial dressing.

     Regardless of the method used for debridement, the goal of therapy should consider debridement urgency, provider skill level, patient or caregiver’s ability to follow the plan of care, and care setting. Non-traumatic wound debridement can help decrease pain, foster better cooperation with the care plan, and be easily performed in most settings.

Pearls for Practice is made possible through the support of Ferris Mfg. Corp, Burr Ridge, IL (www.polymem.com). The opinions and statements of the clinicians providing Pearls for Practice are specific to the respective authors and are not necessarily those of Ferris Mfg. Corp., OWM, or HMP Communications. This article was not subject to the Ostomy Wound Management peer-review process.