17.4 Debridement guidelines

Please refer to:

Debridement is the removal of devitalised or contaminated tissue from a wound until healthy tissue is exposed and should be seen as part of the healing process. Debridement may be necessary before a wound can be fully assessed, as much of the wound may be concealed.

Necrotic material varies from hard black eschar to soft slough, which may be yellow, brown or green. The presence of devitalised tissue may pre-dispose a wound to clinical infection. The wound should be closely watched for signs of infection. Specimens are only required if there are clinical signs of infection. Discussions with the doctor should take place; consider referral to Tissue Viability Service.

Debridement can sometimes be a slow process with passive dressing approaches which can be significantly enhanced by use of the NICE approved active mechanical method reducing time to healing.

Autolytic debridement hydrates and digests hard eschar and soft slough. It uses the body's own enzymes and moisture for softening and liquification of the necrotic tissue. This is achieved by covering the wound with an occlusive or semi-occlusive dressing.

Hydrogels enhance autolysis by re-hydrating necrotic eschar and slough and are cost-effective and simple to use. They require a secondary dressing and care should be taken to ensure maceration does not occur.

Conservative sharp debridement (cutting within dead tissue): any staff member undertaking sharp debridement must work within their competencies and professional codes of conduct if undertaking sharp debridement. Podiatrists as part of their training obtain competencies in sharp debridement. Refer to employing organisations local policies, procedures and guidelines.

Mechanical debridement: a recent addition to debridement products is Debrisoft® (see adjunct dressings and appliances) which is a soft pad that can be used to remove soft slough from the wound bed and also is useful in removing skin scale.

Larval therapy

Biological debridement utilises fly maggots to ingest necrotic tissue. It is fast and effective, but advice must be sought from tissue viability before applying to ensure appropriate application. Maggots may be prescribed by supplementary prescribers under a Clinical Management Plan.

If you are not competent in applying this therapy please refer to Specialist Tissue Viability nurse for guidance.

The prescribing and ordering of larval therapy:

  • Larval therapy is available on FP10 but not on the community practitioners formulary
  • All larvae obtained through Biomonde Ltd (Tel 0845 230 1810; Fax 01656 668047; e-mail orders@biomonde.com)
  • Need to be ordered before 14.00hrs on the preceding day to ensure a delivery before midday on the required day.
  • All larvae should be kept in a cool area until required.
  • Larvae come free range or in bags
  • Specialist advice should be sought if additional information is required regarding presentation of larvae to be used, or in difficult to dress areas.

 

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