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Wound Management

Introduction and theory

Authors:  Christian Kaare Paaskesen Stud. Med., and Hasan Gökcer Tekin MD.

Introduction

Surgical debridement is one of the most important procedures in wound management and wound-bed preparation. The procedure involves removal of debris and devitalized tissue with sharp surgical instruments. Debridement is necessary to promote wound healing, as the avital tissue and debris delays formation of new healthy tissue and keeps the wound in a prolonged chronic state.

Theory

Necrotic tissue may serve as a culture medium for bacteria, and an imbalance of bacterial colonization may impair wound healing (1). Debridement is defined as the removal of foreign matter and necrotic tissue in a wound. The purpose is to promote the formation of granulation tissue and consequently epithelialization.

Surgical debridement is the most direct form of debridement and is considered the most rapid and efficient type of debridement. Scalpels, scissors and curettes or other sharp instruments are usually preferred in surgical debridement (2). Descriptions of scalpels and scissors can be found in the chapter “Surgical instruments”. The curettes comes in various forms and has the purpose of scraping /debriding the wound superficially.

The curettes comes in various forms and has the purpose of scraping /debriding the wound superficially.

The surgeon must pay special attention to underlying structures in the area being debrided, such as superficial veins. When debriding below fascial levels, it is important to be aware of larger arteries and nerves. Breaking the facia will make these structures more prone to infections and necrosis.

Sufficient blood supply must be available before surgical debridement to achieve wound healing following surgery, it is advised to use only light haemostasias and wound edges should be trimmed until punctual bleeding.

References

  1. Robson MC, Stenberg BD, Heggers JP. Wound healing alterations caused by infection. Clin Plast Surg 1990;17:485–492.
  2. Steed DL. Debridement. Am J Surg. 2004 May;187(5A):71S-74S. doi: 10.1016/S0002-9610(03)00307-6. PMID: 15147995.

Procedures

Procedures