Debridement

Debridement is the removal of devitalized tissue.  No one knows exactly what that means but it includes taking off tissue that bacteria has killed on the surface of the wound.  It also includes removing bacteria and other things which keep the wound from healing.  So debriding a wound is a very positive thing and helps the wound heal much quicker, but it has one problem.  It can be painful.

 

We are very sensitive to the pain that debridement may cause.  Every patient has a numbing gel placed on the wound when we prepare the wound.  This is often enough to allow debridement without any pain but even if it does not fully numb the wound it does allow us to use numbing shots, which will further control the pain.  We are doing other things to limit the amount of debridement that is necessary.  Those things are using enzymes to dissolve the dead tissue and bacteria off the surface of the wound.  But these strategies just are not good enough at the present time in removing the dead tissue so debridement remains the best thing for the wound. 

 

You may ask, if debridement can be painful, why do we keep doing it?  It also seems confusing that to get a wound to heal we have to keep cutting the surface off.  This seems like it would slow down the progress of wound healing.  To answer these questions we have to look at why chronic wounds don’t heal. 

 

All tissues suffer from chronic infections.  In the sinuses, you get chronic sinus infections.  In tonsils you get chronic tonsillitis.  Chronic infections of the heart valve are called endocarditis.  The point is, all tissues suffer from chronic infections.  Chronic wounds are just chronic infections of the skin.  And it is the bacteria tightly stuck on the surface of the tissue, which causes the inflammation and pain and the continued dying of the tissue of the surface of the wound.  Debridement allows us to remove this film of bacteria, which prevents wound healing and then we can put things on the surface of the wound that prevent that film from reforming.  This is what allows the wound to heal.  This is why debridement is so very important.