Debridement

It is with great pleasure that I have an opportunity to use my degree in French in describing a common term in wound care. Debridement, pronounced correctly, DAY-BREED-MAW, is a French word in origin, but it is still pronounced just a correctly as you would read it in English and it isn’t required to say it with a French accent, in fact, I don’t do so more than half the time.

What is debridement?

Debridement is the medical removal of unhealthy, nonviable, or damaged tissue and foreign matter from a wound. The name comes from mid-19th century French meaning to ‘unbridle.’ During normal, healthy wound healing, the body sends neutrophils and macrophages to clean up the wound bed of the cellular debris, and dead tissue. This process isn’t always sufficient and is overwhelmed by the task at hand, requiring medical debridement to assist in the process, which starts to answer the question, “why debride?”

Why debride?

he other day, a patient looked up at me very confused. “Doc, what are you doing? It seems that you’re making my wound worse. I mean, you’re making it bleed…” This was more my fault for not explaining prior to treatment, but it brought up a good point. Why do we debride? Callus and wound debridement is an integral part of the management of Diabetic foot wounds, but if you the patient or family member are unaware of the reasoning behind such treatment, it would appear that we’re making matters worse. Debridement allows for the removal of free-living bacteria and the biofilms they place over wounds, it stimulates natural growth factors, and debridement removes cells that lack the oomph to heal a wound. Cells become senescent or lazy and they lack the ability to migrate and heal a wound. These cells then get in the way of the healing process and need to be removed. Research has shown that in diabetic wounds, serial debridement reduces the wound area by 54% compared to wounds which are not debrided. (1)

Why don’t we debride every wound?

Dermal Curette

Dermal Curette

This is a question that I was pondering quite a bit after I scraped my elbow and I developed a wound as it healed. Why am I not scraping away at my elbow like I do for my patients in the wound clinic? The answer lies in the fact that with my young elbow, a tiny scrape can be simply managed by the neutrophils and macrophages that are available. These cells clean up the wound and are not overwhelmed. There is not enough tissue loss to warrant debridement. Likewise, not all wounds need to be cleaned in such an aggressive manner. With that said, diabetic foot wounds and many other lower extremity wounds that are present because of pathological process need debridement to assist in the healing. Weekly debridement of wounds is so common that it is termed maintenance debridement. (2)

References:

1. Cardinal M et al: Serial surgical debridement: A retrospective study on clinical outcomes in chronic lower extremity wounds, Wound Repair Regen, 17(3):306-311, 2009
2. Bryan RA, and Nix DP. Acute & Chronic Wounds: Current Management Concepts, 4th ed. Elsevier-Mosby. St. Louis, Missouri 2012.

Images:

LERmagazine.com
Amazon.com (Miltex dermal curette)

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