Wound debridement

About wound debridement

Normally, your body’s natural healing processes help wounds to repair themselves. Sometimes, however, the healing process is interrupted and the tissue in and around the wound dies. When this happens, it’s necessary to remove the dead and damaged tissue. This is called wound debridement.

Wound debridement happens naturally (this is called autolytic debridement) but it takes time. Studies have shown that if the process of debridement is speeded up, the wound heals more quickly.

Wounds that often need debridement include surgical wounds that have become infected or open up after surgery, and chronic wounds such as bed sores and leg ulcers. The term chronic refers to how long you've had your wound for, not how serious it is.

Preparing for a wound debridement

Your nurse or surgeon will explain how to prepare for your wound debridement.

Wound debridement may be done under a local, regional or general anaesthetic. Regional and local anaesthesia completely blocks pain from the wound area and you will stay awake during the procedure.

If you have general anaesthesia, this means you will be asleep during the procedure. You will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. You may be allowed to drink clear fluids until two hours before the anaesthetic; however it’s important to follow your surgeon’s advice.

Your nurse or surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during wound debridement

There are a range of different methods available for wound debridement. The most commonly used methods of debridement are listed below. Your surgeon will recommend the one that is most suitable for you. 

  • Autolytic debridement. This method helps your body’s natural healing processes to remove the dead tissue by itself. For example, if the tissue on your toe is severely damaged, it can be left to liquefy and drop off naturally. Your nurse will ensure that your wound is kept moist by keeping it closed, or partially closed, or by using special dressings. This is considered the safest type of wound debridement and is commonly used. However, it can take some time.
  • Larval therapy (biological debridement). The dead tissue is removed using maggots that are specially grown in a laboratory. The maggots help to liquefy the dead tissue in the wound. They then eat the tissue, which clears the wound of bacteria and infection. The wound is covered by a loose dressing when the maggots are in place. They are removed after 48 to 72 hours of treatment. This is a quick, targeted method of wound debridement.
  • Sharp debridement. The dead tissue is cut away using a scalpel, scissors and forceps. Sharp debridement is only suitable for surface wounds, and it doesn’t result in total debridement so often requires repeat treatment.
  • Surgical debridement. The dead tissue is cut away using a scalpel and scissors along with some healthy tissue by a surgeon. Surgical debridement is a very quick and thorough method of debridement. However, it’s usually only used if there is severe tissue damage and risk of blood poisoning.
  • Chemical treatments. The dead tissue is treated with chemical agents such as iodine, cadexomer iodine, chlorhexidine or silver. Chemical treatments may be applied as a lotion or as part of a dressing.
  • Ultrasound wound treatment. Chronic wounds can be cleaned using sound waves. An ultrasound device with a built-in irrigation system is used to loosen the dead tissue and clean the wound.

What to expect afterwards

If you had a general anaesthetic, you may need to rest until the effects of the anaesthetic have passed. After a local or regional anaesthetic it may take several hours before the feeling comes back into the treated area. Take special care not to bump or knock the area.

You may need pain relief to help with any discomfort as the anaesthetic wears off.

You will usually be able to go home when you feel ready.

If you had a general anaesthetic, you will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours after your wound debridement. General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon’s advice.

Your nurse will give you advice about caring for your healing wound before you go home. You may be given a date for a follow-up appointment.

Recovering from wound debridement

The length of time your wound takes to heal will vary. It's important to follow your surgeon’s advice and look out for signs of infection. If your wound becomes infected, it may: 

  • become more painful
  • look red, inflamed or swollen
  • leak or weep liquid, pus or blood
  • smell unpleasant

You should contact your nurse or surgeon for advice if you think you have an infection.

What are the risks?

As with every procedure, there are some risks associated with wound debridement. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you. 

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure, for example feeling sick as a result of the general anaesthetic.

You may feel some discomfort in the wound area after debridement, but this is usually only temporary.

Complications

Complications are when problems occur during or after the procedure. Complications of wound debridement can include the following.

  • Bleeding – this is usually mild and can be treated quickly.
  • Infection – this is a risk associated with autolytic debridement.
  • Tissue damage – this is a risk associated with chemical debridement.
  • Allergic reaction – this may happen with chemical debridement, but can be treated with medicines.

If you notice any symptoms of these complications, seek urgent medical attention.

Are there any alternatives to wound debridement?

Answer

If you have a chronic wound that has dead tissue in or around it, debridement is the only effective way to help it heal. The term chronic refers to how long you've had your wound for, not how serious it is.

Explanation

Chronic wounds containing dead tissue are often unable to heal themselves. Debridement is necessary to clear the wound to help get the healing process started again.

If the dead tissue isn’t removed from the wound, you may have:

  • an infection or an abscess (pocket of pus)
  • ongoing pain and swelling
  • delayed or impaired healing
  • raised scars

It’s therefore important that the dead tissue is removed as quickly as possible to prevent infection and help the wound heal.

Will I need my wound debrided more than once?

Answer

Yes, you may need your wound debrided more than once. This will depend on the severity of your wound and your treatment plan. 

Explanation

If you have had the wound for a long time, you may need to have it debrided more than once. At the first debridement, you will have the dead tissue removed. Afterwards, you will have regular follow-up appointments to check that the wound is healing. If the wound doesn’t heal, then it’s possible you may need to have another debridement to remove any extra dead or damaged tissue.

Also, depending on the type of wound debridement you initially had, you may need follow-up treatment using another form of debridement. For example, autolytic debridement is often followed-up by larval therapy to help speed up the process of debridement. Surgical or sharp debridement may be followed-up by larval therapy or autolytic debridement.

I don’t like the thought of having maggots on my body. Will I have a choice in whether or not I have larval therapy?

Answer

You don’t have to have larval therapy (biological debridement) if you don’t like the thought of it. However, it has been shown to have several benefits over other types of debridement. 

Explanation

Using maggots to treat wounds sounds like a treatment from the dark ages. But in recent years it has become a readily available form of wound debridement.

The benefits of using maggots over other types of debridement have been well documented. It’s a fast and selective way of clearing a wound of dead or damaged tissue. It’s also thought to reduce the amount of bacteria in the wound and stimulate healing.

However, not everyone is comfortable having this type of treatment. If you don’t want to have larval therapy, tell your nurse or healthcare professional how you feel. They will be able to discuss other types of debridement that may be suitable for you.