“To debride or not to debride? That is the question”.
By Dr. Helen Rees, B. Sc (Hons)
A critical question in the treatment of chronic wounds, diabetic foot ulcers, venous ulcers and pressure ulcers, is whether and how frequently debridement is needed.
Debridement is defined by Hinchcliffe et al (2008) as the removal of slough, surface debris and infected matter from the wound bed in an attempt to leave clean, viable tissue. Methods of debridement include sharp, mechanical, chemical, maggot therapy, surgical, autolysis and ultrasonic.
As skilled practitioners Podiatrists/ Chiropodists are ideally placed to undertake sharp debridement, a fundamental technique in daily clinical work, as long as it is remembered not to go beyond clinical scope of practice. It is essential to undertake a thorough vascular and neurological assessment prior to picking up a scalpel and be aware of the debridement risks if ischemia, poor venous return or poor tissue viability is recorded.
Debridement promotes healing by converting a chronic nonhealing wound environment into the ideal wound bed preparation, promoting wound healing. In addition to altering the environment of the chronic wound, debridement is a technique aimed at removing non-viable and necrotic tissue, thought to be detrimental to healing (Lebrum et al 2010 and Gordon et al 2012).
Debridement is achieved by removing wound edge tissue, such as hyperkeratotic epidermis (callus) and necrotic dermal tissue, foreign debris, and bacterial elements known to have an inhibitory effect on wound healing (Edmonds and Foster, 2006). Research by JAMA dermatology proved that patients with chronic wounds coming in every week for debridement were associated with faster wound healing.
The Royal College of General Practitioners’ Guidelines (RCGP, 2000) recommends debridement as a treatment of diabetic foot ulcers alongside local wound management and appropriate dressings. Debridement is also recommended by the SIGN guidelines (1997), in conjunction with antibiotic therapy for infection and offloading modalities.
While the rationale for debridement seems logical, the evidence to support its use in enhancing healing is scarce. One of the most fundamental practices, debridement, has never been studied closely in randomized clinical trials.
So, as a Chiropodist/ Podiatrist, should we bring our patients in for wound/ ulcer debridement? If so how often should we be debriding?
Let’s discuss this topic further, please add your comments: