Nobody: What’s debridement?
Me: Glad you asked!
According to the Oxford dictionary, the literal definition is: “the removal of damaged tissue or foreign objects from a wound”
According to me, its fun.
All jokes aside, debridement is an essential form of treatment in wound management, especially in patients that have ulcers as a result of their diabetes. There are two essential forms of debridement: surgical and non-surgical. As per my previous statement, it should be easy to figure out which type would be my favourite.
SURGICAL! Its.. the surgical type. I have no shame in admitting that.
Now.. the purpose of debridement is to remove tissue that compromises tissue viability. I sound pedantic, but what I’m trying to say is that debridement helps remove things from the wound that could slow down the healing process.
As mentioned previously, there’s two kinds of debridement: surgical and non-surgical
Surgical Debridement:
Involved using a surgical instrument called a scalpel, that you attach a surgical blade onto. The blade is what ACTUALLY does the “removing” the scalpel handle is what is used as a way to guide the blade, because guiding a surgical blade with your bare hands is nonsense. NONSENSE I TELL YOU!
Non-Surgical Debridement: Autolytic, Enzymatic, Mechanical and Maggot Therapy.
The first kind: Autolytic is the most conservative type of debridement where the body’s own enzymes are used in order to “liquify (you have no idea how I wanted to write “Smoothie” instead of liquify *eye roll*), rehydrate and soften” tissue that is no longer seen as viable. This is an incredibly selective process where only the necrotic tissue (dead tissue) would be removedusing the body’s own phagocytic cells and proteolytic enzymes.
Next: Enzymatic Debridement. These are chemical enzymes obtained from microorganisms; that help cause the disintegration of necrotic (dead) tissue. This method is often a long-term care environment, a painless method that nurses can apply daily.
Mechanical Debridement: is done by irrigation. Hydrotherapy is used to remove dead and unwanted tissue. Mainly instruments used are a syringe, and a catheter tube.
Biological Debridement: Larvae therapy, yes as in .. Maggots. *barf* a specific species of larvae are used, Lucilia Sericata, or in layman’s terms, the green bottle fly, are used on the wound and they only eat dead tissue and produce the following enzymes: carboxypeptidases A and B; leucine aminopeptidase; collagenase; and serine proteases. These are digestive enzymes and help in the breakdown, liquidizing and eat the broken downproduct. The whole thing is very, very gross but it’s a very good thing!
Benefits of Debridement:
There are plenty of benefits of debriding wounds, especially chronic wounds in diabetic patients such as diabetic ulcers because not only does it promote healing by releasing growth factors by stimulating the edge of the wound, but it also removes dead tissue which bacteria survive on and it reduces the environment in which bacteria can double or triple. Debridement is seen as a method of preparing the wound for reepithelialization (restoring viable tissue) and this has been generally accepted canon for over a decade. The main steps to follow are D.I.M.E
D: debridement
I: Infection and Inflammation management
M: moisture control
E: Environment and Epithelialization assessment.
For podiatry students who want to practice debridement techniques such as surgical debridement, a third year podiatry student advices me to practice on melted wax and gently slough off the wax in order to practice precision and pressure management.
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