II. Goal

  1. Preserve granulation tissue (pink)
  2. Debride fibrin tissue (white, yellow, or green tissue)
  3. Debride necrotic tissue (black wound)
    1. Full thickness burn (Third Degree Burn)
    2. Pressure Sore (Stages 3 or 4)
    3. Gangrenous ulcer
  4. Exceptions: Stable healing ulcer with dry eschar
    1. Dry eschar does not require debridement
    2. Debridement indications
      1. Edema or erythema
      2. Fluctuance
      3. Discharge

III. Techniques

  1. Sharp Debridement
    1. Scalpel or scissors to remove devitalized tissue
    2. Indications
      1. Removing adherent eschar
      2. Devitalized, necrotic tissue in extensive ulcer
      3. Urgent debridement in advanced Cellulitis or Sepsis
    3. Follow-up Sharp Debridement
      1. Apply clean, dry dressings for 8-24 hours
      2. Restart wet-to-moist (or wet-to-dry) dressings
    4. Debridement under Anesthesia Indications
      1. Indicated for extensive stage 4 Decubitus Ulcers
      2. Consider bone biopsy to assess for Osteomyelitis
  2. Mechanical Debridement
    1. Wet-to-Dry Dressing
    2. Hydrotherapy (Occlusive Wound Dressing)
      1. Transparent Film Dressing
    3. Wound irrigation
    4. Dextranomers
  3. Enzymatic Debridement (chemical debridement)
    1. Indicated where surgical debridement is not possible and wound infected or dead tissue
    2. Papain-urea (e.g. Accuzyme, Panafil)
    3. Trypsin-balsam peru-Castor oil (e.g. Xenaderm)
    4. Collagenase (Santyl)
  4. Autolytic Debridement
    1. In vivo enzymes self-digest devitalized tissue
    2. Contraindicated for infected wounds
    3. Synthetic dressing applied to cover wound
      1. Mildly draining wounds: Hydrogel Dressing, Hydrocolloid Dressing
      2. Moderately to strongly draining wounds: Alginate Dressing

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