Debridement

Debridement is the medical removal of a patient's dead, damaged, or infected tissue

Tissue (biology)

Tissue is a cellular organizational level intermediate between cells and a complete organism. A tissue is an ensemble of cells, not necessarily identical, but from the same origin, that together carry out a specific function. These are called tissues because of their identical functioning...

 to improve the healing potential of the remaining health

Health

Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain...

y tissue. Removal may be surgical

Surgery

Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

, mechanical, chemical, autolytic

Autolysis (biology)

In biology, autolysis, more commonly known as self-digestion, refers to the destruction of a cell through the action of its own enzymes. It may also refer to the digestion of an enzyme by another molecule of the same enzyme....

 (self-digestion), and by maggot therapy

Maggot therapy

Maggot therapy is a type of biotherapy involving the intentional introduction of live, disinfected maggots into the non-healing skin and soft tissue wound of a human or animal for the purpose of cleaning out the...

, where certain species

Species

In biology, a species is one of the basic units of biological classification and a taxonomic rank. A species is often defined as a group of organisms capable of interbreeding and producing fertile offspring. While in many cases this definition is adequate, more precise or differing measures are...

 of live maggot

Maggot

In everyday speech the word maggot means the larva of a fly ; it is applied in particular to the larvae of Brachyceran flies, such as houseflies, cheese flies, and blowflies, rather than larvae of the Nematocera, such as mosquitoes and Crane flies...

s selectively eat only necrotic

Necrosis

Necrosis is the premature death of cells in living tissue. Necrosis is caused by factors external to the cell or tissue, such as infection, toxins, or trauma. This is in contrast to apoptosis, which is a naturally occurring cause of cellular death...

 tissue.

In oral hygiene

Oral hygiene

Teeth cleaning is part of oral hygiene and involves the removal of dental plaque from teeth with the intention of preventing cavities , gingivitis, and periodontal disease. People routinely clean their own teeth by brushing and interdental cleaning, and dental hygienists can remove hardened...

 and dentistry

Dentistry

Dentistry is the branch of medicine that is involved in the study, diagnosis, prevention, and treatment of diseases, disorders and conditions of the oral cavity, maxillofacial area and the adjacent and associated structures and their impact on the human body. Dentistry is widely considered...

, debridement refers to the removal of plaque

Dental plaque

Dental plaque is a biofilm, usually a pale yellow, that develops naturally on the teeth. Like any biofilm, dental plaque is formed by colonizing bacteria trying to attach themselves to a smooth surface...

 and calculus

Calculus (dental)

In dentistry, calculus or tartar is a form of hardened dental plaque. It is caused by the continual accumulation of minerals from saliva on plaque on the teeth...

 that have accumulated on the teeth. Debridement in this case may be performed using ultrasonic

Ultrasound

Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...

 instruments, which fracture the calculus, thereby facilitating its removal, as well as hand tools, including periodontal scaler

Periodontal scaler

Periodontal scalers are dental instruments used primarily in the prophylactic and periodontal care of human teeth. The working ends come in a variety of shapes and sizes, but they are always narrow at the tip, so as to allow for access to narrow embrasure spaces between teeth...

 and curettes

Periodontal curette

A periodontal curette is a dental instrument used primarily in the prophylactic and periodontal care of human teeth. The working tips are fashioned in a variety of shapes and sizes, but they are always rounded at the tip in order to make subgingival cleansing less traumatic to the gingiva...

, or through the use of chemicals such as hydrogen peroxide

Hydrogen peroxide

Hydrogen peroxide is the simplest peroxide and an oxidizer. Hydrogen peroxide is a clear liquid, slightly more viscous than water. In dilute solution, it appears colorless. With its oxidizing properties, hydrogen peroxide is often used as a bleach or cleaning agent...

.

In podiatry

Podiatry

Podiatry is a branch of medicine devoted to the study, diagnosis, and treatment of disorders of the foot, ankle, and lower leg. The term podiatry came into use first in the early 20th century United States, where it now denotes a Doctor of Podiatric Medicine , a specialist who is qualified by their...

 practitioners such as chiropodists, podiatrists and foot health practitioner

Foot health practitioner

A Foot Health Practitioner is a provider of routine foot care working in the private sector. The title is most used in the United Kingdom and the Republic of Ireland. FHPs undertake training to recognise, assess and treat foot conditions....

s remove callus, corns, verrucas etc.

Debridement is an important part of the healing process for burn

Burn

A burn is an injury to flesh caused by heat, electricity, chemicals, light, radiation, or friction.Burn may also refer to:*Combustion*Burn , type of watercourses so named in Scotland and north-eastern England...

s and other serious wounds; it is also used for treating some kinds of snake bites.

Sometimes the boundaries of the problem tissue may not be clearly defined. For example, when excising a tumor, there may be micrometastases

Micrometastasis

Micrometastasis is a form of metastasis in which the newly formed tumors are too minuscule to be detected...

 along the edges of the tumor that are too small to be detected, and if not removed, could cause a relapse. In such circumstances, a surgeon may opt to debride a portion of the surrounding healthy tissue — as little as possible — to ensure that the tumor is completely removed.

Autolytic debridement

Autolysis uses the body's own enzymes and moisture to re-hydrate, soften and finally liquefy hard eschar

Eschar

An eschar is a slough or piece of dead tissue that is cast off from the surface of the skin, particularly after a burn injury, but also seen in gangrene, ulcer, fungal infections, necrotizing spider bite wounds, and exposure to cutaneous anthrax....

 and slough. Autolytic debridement is selective; only necrotic tissue is liquefied. It is also virtually painless for the patient. Autolytic debridement can be achieved with the use of occlusive or semi-occlusive dressings which maintain wound fluid in contact with the necrotic tissue. Autolytic debridement can be achieved with hydrocolloids, hydrogels and transparent films.

Advantages

• Very selective, with no damage to surrounding skin.
• The process is safe, using the body's own defense mechanisms to clean the wound of necrotic debris.
• Effective, versatile and easy to perform
• Little to no pain for the patient

Disadvantages

• Not as rapid as surgical debridement
• Wound must be monitored closely for signs of infection
• May promote growth of anaerobic organism
  Anaerobic organism
  An anaerobic organism or anaerobe is any organism that does not require oxygen for growth. It could possibly react negatively and may even die if oxygen is present...
  
  s if an occlusive hydrocolloid is used

Enzymatic debridement

Chemical enzymes are fast acting products that produce slough of necrotic tissue. Some enzymatic debriders are selective, while some are not.

Disadvantages

• Expensive
• Requires a prescription
• Application must be performed carefully only to the necrotic tissue.
• May require a specific secondary dressing
• Inflammation or discomfort may occur

Mechanical debridement

This technique has been used for decades in wound care. Allowing a dressing to proceed from moist to wet, then manually removing the dressing causes a form of non-selective debridement.

Hydrotherapy is also a type of mechanical debridement. Its benefits versus risks are of issue.

Disadvantages

• Non-selective and may traumatize healthy or healing tissue
• Time consuming
• Can be painful to patient
• Hydrotherapy can cause tissue maceration. Also, waterborne pathogens may cause contamination or infection. Disinfecting additives may be cytotoxic.

Surgical debridement

Sharp surgical debridement and laser debridement under anesthesia are the fastest methods of debridement. They are very selective, meaning that the person performing the debridement has complete control over which tissue is removed and which is left behind.
Surgical debridement can be performed in the operating room or at bedside, depending on the extent of the necrotic material.

Best uses

• Wounds with a large amount of necrotic tissue.
• In conjunction with infected tissue.

Disadvantages

• Painful to patient
• Requires anaesthesia, if the wound is large
• Costly, especially if an operating room is required
• Requires transport of patient if operating room is required
• Surgical complications

External links

• Debridement lecture (pdf)