Debridement is considered a cornerstone in wound care. Common sense dictates only a clean wound heals. Observing animals lick their wounds adds to this.
It remains the question if and how debridement translates to the clinical practice.
IF: Wilcox checked this in 2013. In a study of 154 644 patients with 312 744 wounds of all causes debridement were checked as a parameter. He found the following. The more frequent the debridements, the better the healing outcome. Although limited by retrospective data, this study’s strength was the analysis of the largest wound data set to date.
The bias is in the quality of the data where you do not know if debridement was the only parameter which differs between the groups, however this is offset by “n”, the sheer number of subjects. They explain further in the article.
The best way to debride is to surgical debridement were all dead material is removed using scalpels, forceps, scissors etcetera. If sharp debridement is not possible alternative methods may be used.
It is important to also keep biofilms in mind, they may be not visible. In a non-healing wound it should be removed, in a healing wound it may be wise to leave it in situ. Common sense dictates removing is more damaging than leaving it in situ.
Frequency of Debridements and Time to Heal: A Retrospective Cohort Study of 312 744 Wounds. James R. Wilcox, RN ; Marissa J. Carter, PhD, MA; Scott Covington, MD
http://archderm.jamanetwork.com/article.aspx?articleid=1720508
HOW: debridement works seems simple but leads to other questions. It works because you remove debris and other causes of infection in the wound.You also help the body removing unwanted material. But if you rephrase the answer to it works because you remove barriers to healing you may have to take a second look. Not only debris itself but also tissue directly adjacent to the wound may be a barrier to healing. This leads to the question: which living tissue is a barrier to healing. ..the road to debridement 2.0
Debridement 2.0
Sometimes it may make sense to debride the wound to the point where you remove some living tissue as well. For instance in burns. Presumably in the near future we discover other instances where removing living tissue. Al in all the affected area is usually larger than the wound itself. This is often overlooked in research. Subjects: burn wounds, but also scar tissue and, but we do not know that, metabolically impaired tissue. This is one of the almost uncharted areas in wound care.
In some cases a closer observation will reveal which “visible” healthy tissue is compromised. This allows to identify and remove more damaged tissue. In the future, this may speed up healing.
Using Gene Transcription Patterns (Bar Coding Scans) to Guide Wound Debridement and Healing
Marjana Tomic-Canic, PhD, RN, Director, Elizabeth A. Ayello, PhD, RN, ACNS-BC, ETN, FAPWCA, FAAN, President, Olivera Stojadinovic, MD, Instructor, Michael S. Golinko, MD, MA, General Surgery Resident, and Harold Brem, MD, Chief http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948232/
and
Surgical wound debridement sequentially characterized in a porcine burn model with multispectral imaging.
King DR, Li W, Squiers JJ, Mohan R, Sellke E, Mo W, Zhang X, Fan W, DiMaio JM, Thatcher JE. http://www.ncbi.nlm.nih.gov/pubmed/26073358
Take away:
- Proper debriding makes sense.
- Proper means clean but also by using the right knowledge and skills.
- And thinking on something as simple a removing stuff from a wound may bring progress.
- Agree to disagree…discussion improves wound care
Here is a lecture on debridement.