Debridement Surgery in Delhi, India

Debridement is indicated when wound healing is delayed to the extent that it may lead to gangrene. Dead tissues harbour bacteria that may thrive and cause more extensive infections. Debridement promotes healing and lowers the risk of complications. Debridement may be advised when:

• Serious or chronic wound fails to heal
• Severe burns
• Injuries such as diabetic leg ulcers
• To clear debris that may have entered a wound

Doctors record the patient's medical history and family history and perform a physical examination before the procedure.

Physical Examination

The doctor evaluates the wound to be debrided and decides which type of debridement method would be the best approach to treat the case.

Medical history

The doctor enquires in detail about the patient's medical history and records questions such as:

• Existing medical conditions or any recent ailments, such as a heart condition or blood clots
• Medications or supplements taken, such as aspirin, iron supplements, herbal supplements, ibuprofen, naproxen sodium, or blood thinners
• Allergic to any substances

Diagnostic Tests

Doctors may advise certain tests before the procedure. These may include:

• Blood tests: To assess for the presence of any infection
• Culture tests: To test the type of bacteria present
• Ultrasound: To assess the extent of the damage.

Debridement has a multitude of approaches. These include:

• Biological: This method involves using sterile medical maggots. These are introduced into the wound when they are alive and stored in a sterile bottle. They develop by feeding on the dead tissue without affecting the healthy tissue. Multiple applications of larvae may be required. Biological debridement disinfects the wound and stops the growth of the biofilm.
• Surgical or sharp: Sharp or surgical debridement involves using a scalpel or other surgical tools to cut away nonviable tissue.
• Autolytic: Endogenous enzymes in the wound are used to exudate to maintain a moist wound environment while the nonviable tissue liquefies. Dressings may be used to promote debridement.
• Mechanical: Mechanical debridement abrades the wound surface to remove any unhealthy tissue and requires multiple sessions.
• Enzymatic: Enzymatic debridement uses proteolytic enzymes to break down and dissolve the nonviable tissue.
• Hydrosurgery: Also known as tangential hydro surgery, this method debrides tissues using a high-pressure fluid jet. This jet runs parallel to the wound surface drawing the devitalized soft tissues into the cutting chamber so that they can be cut and removed.
• Ultrasonic: Low-frequency sound waves remove the devitalized tissue. This uses cavitational and microstreaming effects. The sound waves emulsify dead tissues with tiny gas bubbles and stimulate the membranes of healthy cells. Bacteria thus become more susceptible to antibiotic treatment.

A combination of the above methods can be used to achieve a better result.

Debridement is commonly done when a necrotic, devitalized tissue fails to heal. It is an important aspect of wound management. Common indications are:

• Presence of devitalized tissue
• Unhealthy granulation tissue
• Slough or necrosis
• Pressure ulcers or injuries
• Presence of bioburden (build-up of bacterial film layer on the surface of the wound)
• Non-healing wounds
• Burn wounds
• Infected traumatic wounds
• Arterial ulcers with devitalized tissue
• Diabetic ulcers
• Venous ulcers

Contraindication of wound debridement includes the following conditions:

• Dry and intact eschars with no infection
• Pressure ulcer at the sacrum, buttock, or heel
• Other contraindications depend upon the method of debridement
• Granulating Wounds
• Deep Tissue Injuries with intact skin
• Lower extremity blisters
• Dry stable eschars in the lower extremity
• Eschars over a healing wound

Follow the instructions given by the doctor prior to the procedure. Some of which include:

• At the consultation visit for the surgery, the doctor shares details of the procedure and answers queries. The doctor gives the post-operative instructions to follow. A consent form for the surgery is signed at this appointment.
• The doctor reviews the medical history and enquires about any allergies or pre-existing medical conditions. The doctor may advise some blood tests before the procedure.
• Inform the doctor about any ongoing healthcare supplements or prescribed medications being taken.
• The doctor may stop certain medications, such as blood thinners and NSAIDs, before the operation.
• Avoid smoking and drinking since they interfere with the surgical procedure.
• Jewellery, metallic objects, or any other objects that may interfere with the surgery are removed.
• Follow fasting for 12 to 8 hours before the surgery to avoid the side effects of anaesthesia.
• Wear loose, comfortable clothing to the scheduled appointment.

Debridement itself is a safe procedure but may lead to complications depending on the patient's medical history and the doctor's experience. Some complications that may occur include:

• Bleeding
• Irritation
• Damage to healthy parts of the body
• Pain
• Allergic reaction
• Bacterial infection
• Delayed wound healing
• Failure for the wound to heal and a repeat procedure may be required.

Despite these potential complications, it has been well-established that some wounds don't heal without debridement.

The recovery after a debridement procedure takes about six to twelve weeks. Complete recovery depends on the wound's size, location, severity, and the debridement method employed for wound management.

Some instructions given by the doctors to ensure smooth recovery are:

• Eating healthy provides the body with all the required nutrients to heal.
• Avoid smoking since it hampers healing. The smoke contents make it difficult for nutrients and oxygens to reach the wound.
• Regularly visit the doctor for follow-up appointments since they need to evaluate the wound and ensure it is healing well.

What is debridement?

Debridement is a medical procedure used to remove dead, damaged, or infected tissue from a wound.

Why is debridement necessary?

Debridement is necessary to promote healing, prevent infection, and improve the appearance of the wound.

How is debridement performed?

Debridement can be performed by surgical excision, mechanical or enzymatic debridement, or by using special dressings.

What are the types of debridement?

The types of debridement include surgical debridement, mechanical debridement, enzymatic debridement, and autolytic debridement.

What is surgical debridement?

Surgical debridement is a procedure where dead or damaged tissue is removed using a scalpel or other surgical instrument.

What is mechanical debridement?

Mechanical debridement is a procedure where dead or damaged tissue is removed using a specialized tool such as a high-pressure irrigation system, or by gently scrubbing the wound.

What is enzymatic debridement?

Enzymatic debridement is a procedure where dead or damaged tissue is removed using a specialized enzyme that breaks down the tissue.

What is autolytic debridement?

Autolytic debridement is a procedure where dead or damaged tissue is removed by using the body's own natural healing process.

What types of wounds require debridement?

Wounds that are infected, have necrotic tissue, or are not healing properly may require debridement.

Is debridement painful?

Debridement can be painful, but local anaesthesia or pain medication is used to minimize discomfort.

How long does debridement take?

The length of time for debridement depends on the size and complexity of the wound.

Can debridement be performed in a doctor's office?

Debridement can be performed in a doctor's office or in a hospital, depending on the severity of the wound.

How often should debridement be performed?

The frequency of debridement depends on the severity and type of the wound.

Can debridement be performed on all types of wounds?

Debridement may not be suitable for all types of wounds, and a healthcare provider will determine if it is necessary and appropriate.

What are the risks of debridement?

The risks of debridement include bleeding, pain, infection, and scarring.

What are the benefits of debridement?

The benefits of debridement include improved wound healing, reduced risk of infection, and improved wound appearance.

What is the recovery time for debridement?

The recovery time for debridement depends on the type and severity of the wound, but most people resume normal activities in a few days to weeks.

Are there any alternative treatments to debridement?

Alternative treatments for debridement include wound dressings, topical agents, and negative pressure wound therapy.

Can debridement be performed on people with diabetes?

Debridement can be performed on people with diabetes, but special care must be taken to ensure that the wound is properly healed and that infection is minimized.

Can debridement be performed on people with peripheral artery disease?

Debridement can be performed on people with peripheral artery disease, but special care must be taken to minimize the risk of complications such as bleeding or reduced blood flow to the affected area.

Can debridement be performed on people with compromised immune systems?

Debridement can be performed on people with compromised immune systems, but special care has to be taken to minimize the chances of infection and to promote proper wound healing.

Can debridement be performed on people who are pregnant?

Debridement can be performed on people who are pregnant, but special care must be taken to ensure the safety of the mother and the developing fetus.

Can debridement be performed on children?

Debridement can be performed on children, but special care is taken to ensure their comfort and safety during the procedure.

What is the cost of debridement?

The cost of debridement can vary depending on the location, severity, and type of the wound, as well as the type of debridement procedure used.

Can debridement be done at home?

Debridement should only be performed by a trained healthcare professional in a clinical setting, as home debridement can be dangerous and increase the risk of infection.

Can debridement be combined with other wound treatments?

Debridement can be combined with other wound treatments, such as wound dressings, antibiotics, and negative pressure wound therapy, to promote healing and reduce the risk of infection.

Can debridement be performed on chronic wounds?

Debridement can be performed on chronic wounds, but special care must be taken to address underlying conditions that may be contributing to the slow healing process.

Can debridement be performed on burns?

Debridement can be performed on burns to remove dead or damaged tissue and promote healing, but the type and severity of the burn determine the type of debridement procedure used.

Can debridement be performed on surgical wounds?

Debridement can be performed on surgical wounds to remove dead or damaged tissue and promote proper healing.

Can debridement be performed on pressure ulcers?

Debridement can be performed on pressure ulcers to remove dead or damaged tissue and promote healing, but the type and severity of the ulcer will determine the type of debridement procedure used.

Can debridement be performed on infected wounds?

Debridement is often performed on infected wounds to remove the source of infection and promote proper healing.

Can debridement be performed on gunshot wounds?

Debridement can be performed on gunshot wounds to remove dead or damaged tissue and promote proper healing.

Can debridement be performed on animal bites?

Debridement can be performed on animal bites to remove dead or damaged tissue and reduce the risk of infection.

Can debridement be performed on wounds with foreign objects?

Debridement can be performed on wounds with foreign objects to remove the object and promote proper healing.

Review

Reviewed by Dr KK Trehan, Senior Director - Laparoscopic / Minimal Access Surgery, General Surgery on 29 May 2024.