An overview of debridement techniques

A number of different debridement techniques are available for the management of acute and chronic wounds; as a result the debridement method applied with vary. Methods can be selective or non-selective and this can impact on the surrounding tissue of a wound. This article will look at the various methods of debridement and mechanisms of action which impact on the healing wound and the healthy tissue surrounding it. Debridement is a key aspect of wound management, and decisions on the ideal technique, and the most appropriate method, should be made for optimum healing.

Debridement is defined as removal of a bioburden and foreign material from a wound (Welsh and Sumpling, 2015). Such material may be necrotic tissue, purulent material, haematomas, foreign bodies, debris, and bone fragments (Strohal et al, 2013). The objective of wound debridement is to promote wound healing (Hamilton and Kožár, 2017). Debridement occurs naturally in all wounds and is part of the inflammatory phase of wound healing. It is driven initially by neutrophils and then by macrophages (Davidson, 2015). Veterinary intervention is valuable because failure to debride a wound is likely to delay wound healing as the inflammatory phase is prolonged, and this may predispose the wound to infection (Welsh and Sumpling, 2015). If all wounds are to heal successfully they are required to pass through the three phases of wound healing — inflammation, proliferation and maturation — and if this process is interrupted the wound will become chronic (Woodlands, 2014). Chronic wounds often require intervention to remove necrotic tissue, a blood supply needs to be re-established and exudate removed (Hamilton and Kožár, 2017). Any devitalised tissue can act as a barrier to impede the healing processes (Wiegand et al, 2016). Factors that affect the choice of method of debridement include wound size, location, aetiology, age of the wound, the systemic condition of the patient, and the presence of infection or exudate (Hamilton and Kožár, 2017).