Please refer to:

• NICE NG125 Surgical site infections: prevention and treatment (April 2019)
• NICE CG179: Pressure ulcers: prevention and management (April 2014)

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: Please see 17.5 Adjunct dressings and appliances

Wound debridement of necrotic and sloughing tissues is an essential part of wound cleansing which together with fluid irrigations is required to be undertaken to remove:

• Superficial slough or excessive wound exudates.
• Particulate contamination from dressing material e.g. hydrogel.
• Contamination from debris in traumatic wounds.
• Heavy colonisation, with or without biofilm.

Debriding agents for difficult-to-heal surgical wounds

Alginate, foam, hydrocolloid, hydrogel and polysaccharide dressings, as well as maggots, may reduce pain from difficult-to-heal surgical wounds. There is insufficient evidence to support one debriding agent over another and choice should be based on patient acceptability. This includes factors such as comfort and odour control, exudate management, type and location of the wound, and total cost (including time for changing the dressings).

Larval therapy

This can be recommended for rapid removal of sloughy and necrotic tissue and bacterial load where surgical debridement is not possible.

Information on larval therapy is available via the Tissue Viability services.

Prescribing of larval therapy should be by trained individuals in both hospital and community. Care is advised where the wound is heavily exuding so not to drown the maggots and where there may be pressure that would crush them. The recent change in the methods of breeding larvae has decreased the time necessary on the wound bed to achieve debridement.