Wound Preparation, Debridement and Surgical Closure


Most chronic wounds seen in outpatient settings contain necrotic tissue, exudate and or large amounts of bacteria and biofilm. Removing this material, also known as debridement, eliminates these potential toxins and has been shown in clinical trials to accelerate healing. All physicians should be comfortable debriding wounds as a fundamental skill in wound care. Debridement is most commonly performed using a scalpel/or curette to sharply excise necrotic or infected tissue. However, there are a number of other ways to debride wounds including high pressure irrigation with saline, topically applied enzymes (collagenase) or even maggots. In addition to removing necrotic or infected tissue, debridement is thought to re-activate the wound healing cascade, converting a chronic wound to one that is more like a fresh or “acute” wound. During sharp debridement, all necrotic, devitalized tissue should be removed and the remaining wound should be covered with pink, lightly bleeding tissue. Excessive bleeding can occur but can almost always be stopped with direct pressure applied to the wound for five or ten minutes. Wounds may require debridement more than once. However, once adequately debrided, many wounds will heal by themselves by secondary intention. Those that are large or do not heal can at this point be referred for surgical closure.

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