Jwc ewma final indd

J O U R N A L  O F WO U N D  C A R E   Vo l   2 2 .  N o   1 .  E W M A   D o c u M E N t   2 0 1 3  

S 3 1

Surgicalandsharp

debridement

S

urgical and sharp debridement are rapid 

methods of debridement and have 

been in use for many years. We define 

‘sharp debridement’ as a minor surgical bedside 

procedure, involving cutting away tissue with 

a scalpel or scissors. ‘Surgical debridement’ is 

defined as a procedure performed under general 

anaesthesia, using various surgical instruments.

Despite the major role of surgical debridement 

in current wound management, there is little 

evidence available to document the benefits.

24,126

Indications

In general, surgical debridement should be 

considered only if other techniques are ineffective 

or the condition of the patient requires rapid, 

major intervention.

Indications for sharp and surgical debridement 

include a solid layer of necrotic tissue, when 

excision and immediate grafting are considered 

superior to other methods of reconstruction, and 

when there is a clear demarcation line between 

viable and non-viable tissue.

127

 However, there 

are some exceptions, which will be described  

under contraindications.

Presumed involvement of the deep structures and 

complications are relative indications for surgical 

debridement; damage of the vessels results in 

bleeding, and this may be significant and require a 

surgical approach to arrest it. Damage of the nerves 

and tendons result in loss of function and may also 

require reconstruction. Even minor debridement 

in distant parts of fingers, approximate to the nail 

bed and matrix, may result in impaired nail growth 

that may also require correction in the future.

Surgical debridement may also be a relevant 

method in severe cases of wound infection.

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Action

Sharp debridement is an action that may be 

performed by any kind of medical specialist, 

including nurses, family doctors, dermatologists, 

podiatrists and other personnel without surgical 

background. Local treatment protocols and 

regulatory guidelines regarding the permitted 

functions of different groups of professionals vary 

from country to country and, naturally, must be 

followed. Usually, sharp debridement is performed 

by the patient bed or in the clinic; however, 

specific facilities, such as a treatment room, may  

be an advantage.

Surgical debridement is considered a more 

invasive action, usually performed by surgeons 

(vascular, general, trauma, plastic etc) in a 

facility dedicated to surgical interventions, 

such as an operating theatre or treatment room. 

Due to the invasive aspects of this procedure, 

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S 3 2