Enzymatic debridement is wound care that may be used to help the body heal a wound, when the body’s resources are not effective. In this practice, chemicals containing certain enzymes are applied to the wound on a scheduled basis. These enzymes break down necrotic or dead and/or dying tissue, plus specific proteins, so that the body can reabsorb them. Until 2009, there were a variety of enzymatic debriding substances on the US market. Now there are only a few, and all those brands that contained papain, an enzyme derived from papaya, have been removed due to the potential to cause a severe allergic reaction. The remaining brands of these products can work effectively and are especially indicated when surgical debridement or removal of tissue with a scalpel or laser is impossible, or if a wound is accumulating significant debris that requires removal.
There are many types of wounds that could be candidates for enzymatic debridement, including bedsores or pronounced ulcers on the foot. Typically a wound that isn’t healing needs to be wet and not dry. Also, if there is evidence of infection in the wound, surgical debridement is usually the better choice. Removing bacteria infecting the wound can be as important as removing wound debris that may be halting recovery.
Enzymatic debridement has another advantage. It doesn’t take much training to perform, though care may be needed avoid contact with the wound, and some of the chemicals could affect surrounding healthy skin. With the right instructions, it is frequently used in home settings, and may especially be beneficial when caring for the elderly.
The available debridement formulas do require a prescription in many regions, which may provide needed medical advice to make sure this form of debridement is the best medical choice. Medical experts use enzymatic debridement in places like hospitals or long-term care facilities. This treatment may also be used in impoverished locales with minimal access to doctors or medical facilities, but the chemicals are expensive, which may exclude those with little resources from obtaining them.
Disadvantages of enzymatic debridement include that it can take much longer than surgical debridement. When it is applied on a wound it can cause a stinging sensation that can be mildly to moderately uncomfortable for the patient, and it might cause residual inflammation. This type of treatment also requires bandaging. Wet to dry packing or moistened bandages are needed. The bandaging isn’t that difficult but repeated ripping off of bandages and tape to repeat treatments are very uncomfortable to a patient and may irritate surrounding healthy skin.
Medical experts describe this treatment as “fast,” and this is confusing when estimating wound healing time. Calculations including overall health, size of wound, presence of other wounds, age, and whether or not infections occur. The term "fast" can be interpreted as faster than a wound would heal alone and probably faster than some other forms of debridement. Patients should ask their doctors for a healing time estimate that is specific to their circumstances.