• Debridement of a Wound, Infection, or Burn

    Definition

    Debridement is the removal of unhealthy tissue from a wound to promote healing. It can be done by surgical, chemical, mechanical, or autolytic (using your body's own processes) removal of the tissue.
    Surgical Debridement of Lower Leg Wound
    Nucleus factsheet image
    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    Debridement is used to clean dead and contaminated material from your wound to aid in healing. The procedure is most often done for the following reasons:
    • To remove tissue contaminated by bacteria, foreign tissue, dead cells, or crusting
    • To create a neat wound edge to decrease scarring
    • To aid in the healing of very severe burns or pressure sores (decubitus ulcers)
    • To get a sample of tissue for testing and diagnosis

    Possible Complications

    Complications are rare, but no procedure is completely free of risk. If you are having a debridement, your doctor will review a list of possible complications, which may include:
    • Pain
    • Bleeding
    • Infection
    • Delayed healing
    • Removal of healthy tissue with mechanical debridement
    Factors that may increase the risk of complications include:
    • Infection
    • Pre-existing medical conditions
    • Smoking
    • Diabetes
    • Use of steroid or other immunosuppressive medicines
    • Poor nutrition
    • Poor circulation
    • Immune disorders

    What to Expect

    Prior to Procedure

    Your doctor will likely do the following:
    • Physical exam
    • Take a measurement of the wound
    • Provide pain medicine before changing debridement dressings (for nonsurgical procedures)
    Arrange for a ride to and from the procedure
    If you will be getting general anesthesia, do not eat or drink anything after midnight the night before the procedure

    Anesthesia

    Anesthesia may be used for deep pressure ulcers or other wounds. Local anesthesia will numb the area. General anesthesia will allow you to sleep through the procedure.

    Description of Procedure

    The following four methods are often used in combination:
    Surgical Debridement
    Surgical debridement is done using scalpels, forceps, scissors, and other instruments. It is used if your wound is large, has deep tissue damage, or if your wound is especially painful. It may also be done if debriding your wound is urgent. The skin surrounding the wound will be cleaned and disinfected. The wound will be probed with a metal instrument to determine its depth and locate any foreign matter. The doctor will cut away dead tissue. The wound will be washed out to remove any free tissue. In some cases, transplanted skin may be grafted into place. Sometimes, cutting away the entire contaminated wound may be the most effective treatment.
    Chemical Debridement
    A debriding medicine will be applied to your wound. The wound will be covered with a dressing. The enzymes in the medicine will dissolve the dead tissue in the wound.
    Mechanical Debridement
    Mechanical debridement can involve a variety of methods to remove dead or infected tissue. It may include using a whirlpool bath, a syringe and catheter, or wet to dry dressings. Wet to dry dressing starts by applying a wet dressing to your wound. As this dressing dries, it absorbs wound material. The dressing is then remoistened and removed. Some of the tissue comes with it.
    Autolytic Debridement
    This form of debridement uses dressings that retain wound fluids that assist your body's natural abilities to clean the wound. This type of dressing is often used to treat pressure sores. This process takes more time than other methods. It will not be used for wounds that are infected or if quick treatment is needed. It is a good treatment if your body cannot tolerate more forceful treatments.

    Immediately After Procedure

    Samples of the removed tissue may be sent to a lab for examination.

    How Long Will It Take?

    The length of treatment depends on the type of debridement. Surgical debridement is the quickest method. Nonsurgical debridement may take 2-6 weeks or longer.

    How Much Will It Hurt?

    During a surgical debridement, general anesthesia prevents pain during the procedure. When local anesthetic or sedative is given, some patients report discomfort. Often, patients will be sore while recovering from the procedure. Pain medicines may be given to help relieve pain.
    Mechanical debridement and chemical debridement often cause pain. Pain medicine can be given before changing the dressing to help manage pain.

    Average Hospital Stay

    Depending on the reason for the debridement, you may be able to go home on the same day. If you are already in the hospital, this procedure should not extend your stay.

    Post-procedure Care

    At Home
    It may take the wound many weeks to heal. A specific wound-care program will be suggested to speed your recovery.
    • Follow your doctor's directions for wound care. If you are unsure about any aspect or unable to manage your care, discuss your concerns with your doctor.
    • Keep the wound and dressings clean and dry.
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • Take medicines as ordered. Do not stop medicines early, even if the wound starts to look better.

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occur:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or discharge at the wound site
    • Chalky white, blue, or black appearance to tissue around wound
    • If general anesthesia was used—cough, shortness of breath, chest pain, or severe nausea and/or vomiting
    • Pain that you cannot control with the medicines you have been given
    In case of an emergency, call for medical help right away.

    RESOURCES

    Visiting Nurse Associations of America http://vnaa.org

    Wound Ostomy and Continence Nurses Society http://www.wocn.org

    CANADIAN RESOURCES

    Canadian Association of Wound Care http://www.cawc.net

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html

    References

    Debridement. Visiting Nurse Associations of America website. Available at: http://vnaa.org. Accessed October 20, 2005.

    Golinko MS. Operative debridement of diabetic foot ulcers. J Am Coll Surg. 2008;207 (e1-6).

    Nigam Y, Bexfield A, Thomas S, Ratcliffe NA. Maggot therapy: the science and implication for CAM part I-history and bacterial resistance. Evid Based Complement Alternat Med. 2006;3:223-227.

    Rakel RE, Bope ET. Conn's Current Therapy 2009. 1st ed. Philadelphia, PA: WB Saunders Company; 2008.

    Roberts JR. Clinical Procedures in Emergency Medicine. 3rd ed. Philadelphia, PA: WB Saunders Co; 1998.

    Spires MC. Frontera: Essentials of Physical Medicine and Rehabilitation. Philadelphia, PA: Hanley and Belfus; 2002: chap 96.

    Steed DL. Debridement. American Journal of Surgery. 2004;187(suppl 1).

    Wong CH. Approach to debridement in necrotizing fasciitis. American Journal of Surgery. 2008; 196 (e19-24).

    Revision Information

  • Join WellZones today.

    Make a Change For LifeLearn more

    Wellmont LiveWell is creating a new tradition of wellness in the mountains by providing individuals with tools and encouragement to live healthier lifestyles.

  • HeartSHAPE Spotlight

    At risk for a heart attack? Learn more

    Fight heart disease early and prevent heart attacks with HeartSHAPE® - a painless, non-invasive test that takes pictures of your heart to scan for early-stage coronary disease.

  • Calories and Energy Needs

    Calorie NeedsLearn more

    How many calories do you need to eat each day to maintain your weight and fuel your physical activity? Enter a few of your stats into this calculator to find out.

  • Ideal Body Weight

    Ideal Body WeightLearn more

    Using body mass index as a reference, this calculator determines your ideal body weight range. All you need to do is enter your height.

  • Body Mass Index

    Body Mass IndexLearn more

    This tool considers your height and weight to assess your weight status.


  • Can we help answer your questions?

    Wellmont Nurse Connection is your resource for valuable health information any time, 24 hours a day, seven days a week. Speak to a Nurse any time, day or night, at (423) 723-6877 or toll-free at 1-877-230-NURSE.