When wound management such as dressings and topical medicines is not effective, infections can occur and tissue can die. Debridement can be a viable option for the removal of both infection and necrotic tissue. A physician will examine the wound and determine whether autolytic, chemical, mechanical, surgical or biological debridement is required. During a debridement procedure on an open wound, the surgeon removes dead tissue, abscesses and other infections to provide a healthier wound environment for healing.
In autolytic debridement, sterile dressings are used to keep the wound moist, and the natural ability of the body is used to debride the wound. The dressings are used to trap liquids and enzymes in the wound. These liquids break down and liquefy only the necrotic tissue. This method is considered less painful for the patient, but it takes longer than any of the other methods and is not viable in cases of infection.
Chemical debridement introduces selected enzymes into the wound. In order for the enzymes to penetrate the necrotic tissue, the tissue is scored with hash marks. Antibiotics and dressings are used to cover and protect the wound as the enzymes break down the necrotic tissue. This process also is considered less painful than some other methods.
A mechanical debridement procedure is considered more painful. In this process, a wet, sterile dressing is applied to the wound and left overnight. As this dressing dries, it sticks to the necrotic tissue. When the dressings are pulled away from the wound, dead tissue comes with it. The dressings sometimes stick to living tissue, however, which could cause pain to the patient.
In surgical debridement, the doctor applies a topical anesthetic before cutting away dead tissue with a scalpel, a pair of scissors or a laser. The doctor firsts explores the wound to determine how deep it is. After the scope of the problem has been determined, forceps are used to hold the edges of the wound open, and the doctor then excises the dead tissue. In this debridement procedure, it might be necessary to leave behind some dead tissue to avoid further damaging living tissue.
The debridement procedure for biological debridement uses maggots, specifically those gathered from the larva of the green bottle fly, as the debriding agent. These maggots are placed in the wound, and the grubs eat the necrotic tissue. They also digest pus, bacteria and other germs. The grubs recognize the difference between healthy and dead tissue, so they leave the healthy tissue alone.