Debridement of a Wound, Infection, or Burn

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Definition | Body Parts Involved | Reasons for Procedure | Complications | What to Expect | Outcome | Call Doctor If

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Definition

Surgical, chemical, mechanical, or autolytic (using the body's own processes) removal of wound or burn tissue to promote healing.

Parts of the Body Involved

Skin, and in some cases, fascia, muscle, or supportive tissue below the surface

Reasons for Procedure

Debridement is used to clean dead and contaminated material from a wound to aid in healing, increase the tissue's ability to resist infection, and decrease inflammation. The procedure is most often performed for the following reasons:

• Remove tissue contaminated by bacteria, foreign tissue, dead cells, or a crust
• Create a neat wound edge to decrease scarring
• Aid in healing very severe burns or pressure sores (decubitus ulcers)

Risk Factors for Complications during the Procedure

• Bleeding
• Infection
• Pre-existing medical conditions
• Smoking
• Diabetes
• Use of steroid or other immunosuppressive medications
• Poor nutrition
• Poor circulation
• Immune disorders

What to Expect

Prior to Procedure

Your doctor will likely do the following:

• Physical exam
• Measurement of the wound
• Provide pain medication before changing debridement dressings (for nonsurgical procedures)

In the days leading up to your procedure:

• Arrange for a ride to and from the procedure
• The night before, eat a light meal and do not eat or drink anything after midnight

During Procedure - Possibly IV fluids and sedation during surgical procedure

Anesthesia - Local or general anesthesia may be used when surgically debriding deep pressure ulcers or other wounds. Anesthesia usually is not given for other methods.

Description of the Procedure

Surgical debridement - The skin surrounding the wound is cleaned and disinfected, and the wound is probed with a metal instrument to determine its depth and locate any foreign matter. The doctor cuts away dead tissue, then washes out any remaining, free tissue. The resulting edge is smooth and usually runs from one end of the wound to the other. In some cases, transplanted skin may be grafted into place. Sometimes, cutting away the entire contaminated wound may be the most effective treatment. The doctor may put drops of dye into the wound to help identify wound tissue. Tissue that turns color is removed, leaving a new clean, surgical wound.

Chemical debridement - The health-care provider applies debriding medication to the wound and covers with a dressing.

Mechanical debridement - A wet dressing is applied to the wound. As this dressing dries, it absorbs wound material. When the dressing is remoistened and removed, some of the tissue comes with it. This process is time-consuming, and may remove healthy or healing tissue along with dead cells. Patients often find this type of mechanical debridement painful. Whirlpool baths are also used for mechanical debridement.

Autolytic debridement - Dressings that retain wound fluids (hydrocolloid, hydrogel, and transparent film) can facilitate the body's natural abilities to clean the wound. This type of dressing is often used to treat pressure sores.

After Procedure- Possibly laboratory examination or culture of removed tissue

How Long Will It Take? This depends on the type of debridement. Surgical debridement is the quickest method; nonsurgical debridement may take 2-6 weeks.

Will It Hurt? During a surgical debridement, general anesthesia prevents pain during the procedure. If a local anesthetic or sedative is given, some patients report discomfort or apprehension during the procedure.

Mechanical debridement and chemical debridement often produce pain. Pain medication can be given before changing the dressing to help relieve the discomfort.

Possible Complications:

• Pain
• Bleeding
• Infection
• Delayed healing
• Removal of healthy tissue with mechanical debridement

Average Hospital Stay - None

Postoperative Care:

• Follow your doctor's directions for wound care. If you are unsure about any aspect or unable to perform the care, discuss your concerns with your doctor.
• Keep the wound and dressings clean and dry.
• Take medications as ordered and do not stop medications early, even if the wound starts to look better.

Outcome

It may take the wound many weeks to heal. A specific wound-care program will be suggested to speed your recovery.

Call Your Doctor If Any of the Following Occurs

• Redness, swelling, increasing pain, excessive bleeding, or discharge at the wound site
• Chalky white, blue, or black appearance to tissue around wound
• Signs of infection, including fever and chills
• Following surgical procedures with general anesthesia: cough, shortness of breath, chest pain, or severe nausea or vomiting

SOURCES:

Clinical Procedures in Emergency Medicine, 3rd ed. W.B. Saunders Co, 1998.

Conn's Current Therapy 2001, 1st ed. W. B. Saunders Co, 2001.

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Last reviewed March 2001 by Medical Review Board