The Importance of Aggressive Wound Debridement to Aid in Healing

Introduction: Debridement of a wound involves the removal of devitalized and necrotic tissue to help promote healing. Devitalized and necrotic tissue inhibits the development of healthy granulation tissue and can also make the wound more susceptible to infection. There are a variety of debridement methods available, including the use of medical-grade maggots, enzymatic debridement, autolytic debridement, mechanical debridement, and surgical debridement. Debridement techniques vary among clinicians who treat hard-to-heal wounds, including their specialty, training, and comfort level in sharp debridement. The author presents a case of a chronic diabetic foot ulceration that was initially treated with less aggressive debridement prior to referral to the author. Once aggressive surgical debridement was initiated, the wound went on to full closure and remains healed.

Methods: A 60-year-old diabetic male was referred to the author with a chronic diabetic foot ulcer sub-fifth metatarsal base of the left foot that was present for nine months. Comorbid medical conditions included type 2 diabetes, lymphedema, rheumatoid arthritis, diabetic peripheral neuropathy, morbid obesity, and a Charcot foot deformity of the right foot. Prior treatment consisted of selective debridement, antibiotics, topical collagen, and surgical shoe immobilization. The wound was treated with aggressive debridement in the wound care setting, topical collagen, and off-loading in a modified surgical shoe. The wound went on to complete closure in 42 days.

Results: Complete closure of a 9-month-old diabetic foot ulceration that did not initially respond to less aggressive debridement went on to full closure with more aggressive debridement. Complications associated with chronic nonhealing wounds, including osteomyelitis, was averted in this case with a more aggressive debridement approach.

Conclusion: Debridement of all necrotic and devitalized tissue is an integral part of wound healing. The author illustrates the importance of aggressive debridement to aid in wound healing.