WOUND

DEBRIDEMENT
why is it important?

DR HANIF KHAIRUDIN
WOUND DEBRIDEMENT
Topic For Discussion

01. Definition

02. Benefits

03. Who needs it?

04. Methods

05. References
Definition

medical removal of
dead/contaminant/non-viable/necrotic/infected/adherent
tissue & foreign body from a wound to improve the
healing potential of the remaining healthy tissue
Benefits
Facilitates Wound Healing:
• Removal of necrotic tissue allows for the initiation of the wound healing process.
• Promotes the formation of healthy granulation tissue and re-epithelialization.

Infection Prevention:
• Eliminates bacterial biofilm and reduces the bacterial load in the wound.
• Reduces the risk of wound infection and systemic infection.

Improved Wound Assessment:

• Enhances the ability to accurately assess the wound's size, depth, and characteristics.
• Facilitates the identification of underlying structures, such as tendons or bones, that may be involved.

Enhances Effectiveness of Wound Care Products:

• Creates an optimal environment for the application of advanced wound care products, such as dressings or topical therapies.
• Improves the penetration and efficacy of antimicrobial agents.
Who needs debridement?
Types of necrotic tissue
METHODS
of wound debridement

Surgical Mechanical Autolytic Enzymatic Biological

Surgical Debridement
Definition
Removal of necrotic tissue by sharp debridement using a scalpel,
scissors, curette, etc to optimise healing

Indication
1. Extensive Devitalized Tissue
2. Signs of advancing soft tissue infections or sepsis
3. Presence of thick adherent eschar
4. Callous formation
Instruments
surgical debridement
Consult Specialist!
1. Vascular insufficiency
2. Gangrenous wound
3. Unidentifiable structures
4. Coagulopathy
5. Stable heel ulcer
6. Fungating/ malignant wounds
7. Necrotic tissues near and/or involving neurovascular structures
8. Wounds of hand and face
Basic Principles
Surgical Wound Debridement

01. Debdride in stages

02. Stay within fascial plane

03. Hemostasis

04. Pain control

Viable vs Non-viable
Viable vs Non-viable (cont)
Mechanical debridement
Wet To Dry Gauze
Usage of gauze to peel the necrotic tissue from the wound bed.
This procedure can be very painful

Scrubbing
Using the blunt edge of the scalpel or forceps to remove
biofilm and debris

Wound Irrigation
Using non antiseptic cleansing solution to irrigate and
debride the wound.

Whirlpool
This utilizes low pressure water force to cleanse and debride the
wound bed. Less harmful to normal cells.
Autolytic debridement
“The process of using the body’s own mechanisms
(enzymes) to remove nonviable tissue”

The collection of fluid at the wound site, “promotes

rehydration of the dead tissue and allows enzymes within the
wound to digest necrotic tissue”

May be accomplished by the use of any moisture-retentive

dressings, i.e. hydrocolloids, hydrogels, hypertonic
dressings/gels, and/or transparent films
Enzymatic debridement
"The use of topically applied enzymatic agents is to
stimulate the breakdown of non‐viable tissue"

Faster debridement process compared to autolytic

Examples are Clostridiopeptidase A , honey and

fibrinolysin with DNAse
Biological debridement
MDT
Maggot Debridement Theraphy
• use of STERILE maggots for the debridement of wounds in humans
• 2 species: Lucilia cuprina (Malaysia and tropical country) and Lucilia
sericata (temperate country)
• Mechanisms of action:
• Remove slough ‐ proteases dissolve necrotic and infective material
(Vistnes 1981, Constable 1994, Case 1994)
• Stimulate wound healing ‐ promote granulation & epithelialization
(Horobin 2003, 2006, Nigam 2006)
• Disinfect the wound ‐ ingest bacteria e.g Proteus sp. (Klaus L 2003) ‐
pH changes ‐ antibacterial substance (<1kD) (Kerridge A 2005)
Thank You!

References

wound care manual KKM

GARIS PANDUAN PERKHIDMATAN PENJAGAAN LUKA DI

FASILITI KESIHATAN PRIMER KKM

South West Regional Wound Care Program