University of California San Francisco

Debridement

Debridement is a procedure for treating a wound in the skin. It involves thoroughly cleaning the wound and removing all hyperkeratotic (thickened skin or callus), infected, and nonviable (necrotic or dead) tissue, foreign debris, and residual material from dressings. Debridement can be accomplished either surgically or through alternate methods such as use of special dressings and gels. 

Debridement is an essential step in the protocol for treating diabetic foot ulcers, which occur in at least 15% of patients with diabetes and precede 84% of all diabetes-related lower-leg amputations. The technique alters the environment of the chronic wound and promotes healing.

Surgical Debridement 

Hyperkeratotic, infected, and nonviable tissue is surgically removed using a scalpel or special scissors. This "sharp debridement" allows the surgeon to clearly visualize the foot ulcer. During the procedure:

  • The skin surrounding the sore or wound is thoroughly cleaned and disinfected.
  • The wound is probed with a metal instrument to determine its depth and to look for foreign material or objects in the ulcer.
  • The hyperkeratotic, infected, and nonviable tissue is excised and the ulcer washed out.

Non-Surgical Debridement 

Alternate methods of debridement include:

  • Autolytic Debridement - This uses the body's own enzymes and moisture to re-hydrate, soften, and liquefy non-viable tissue. Autolytic debridement is selective so that only necrotic tissue is liquefied.  Autolytic debridement can be achieved with hydrocolloids, hydrogels and transparent films.

  • Enzymatic Debridement - Chemical enzymes, derived from microorganisms including clostridium, histolyticum, collagenase, varidase, papain, and Bromelian, are used to slough off necrotic tissue.  

  • Mechanical debridement - Hydrotherapy is the use of water to remove dead and other types of unwanted tissue. The technique includes wound irrigation and therapeutic irrigation with suction, where a syringe and catheter tube is used to wash away dead tissue.
  • Maggot Therapy - A small number of a special species of maggots are introduced into the ulcer. These eat only the dead skin and produce chemicals that promote healing.

Benefits

  • Surgical debridement of a diabetic foot ulcer stimulates the edge of the wound, releases growth factors and reduces inflammation.
  • Removing dead, diseased and infected tissue allows healthy tissue to heal.
  • Eliminates conditions for bacterial overgrowth and other disease processes that could lead to pain, sepsis, and eventually, amputation.