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

special education, qualifications, experience 

and equipment are required before any kind 

of surgical debridement can be performed. The 

surgical debridement procedure may be performed 

as a single procedure, or as the initial phase of 

a reconstructive surgery, where debridement 

is followed by immediate or delayed tissue 

reconstruction, using skin substitute, skin graft  

or composite micro-vascular flap grafting. Surgical 

debridement may be limited to dead tissue 

removal, or excision may be extended to viable 

tissue level to obtain a vital tissue bed. This is 

essential for grafting if immediate reconstruction 

is performed.

Whenever invasive debridement is planned 

(minor sharp debridement or more extended 

surgical debridement), the patient’s general status 

and the anaesthesia requirements should be 

considered. Necessary laboratory tests, such as 

general clinical and blood coagulation, should be 

evaluated before the procedure is initiated. These 

steps are relevant, even if the initial plan for the 

procedure is a minimal invasion one. Biochemical 

blood test and ECG should be performed if an 

extension of procedure is expected; in this case it 

should be followed by general anaesthesia. Ideally 

microbiological investigation of the removed 

tissue should follow the debridement, whenever 

this is possible and affordable.

Sharp and surgical debridement should be 

performed under sterile conditions, regardless of 

the extent of the invasion. The invaded area s 

hould be prepared using antiseptic medication for 

wound and peri-wound skin antisepsis, covered 

with sterile drapes or textiles, and the tissue 

removed or excised using sterile instruments 

(scalpel blade, scissors, forceps) and gloves. Usually 

an antiseptic solution is used to clean the wound 

after the procedure and a sterile dressing containing 

antiseptic is applied.

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 It is recommended that part 

of the removed non-viable tissue, including some 

healthy tissue from the wound margin (biopsy), 

is harvested for microbiological examination, 

in case there are clinical signs of wound critical 

contamination of infection.

Spread of infection may occur when debridement 

is performed. This is often caused by not 

maintaining sterility, an unprepared site, or use 

of an improper drape or non-sterile instruments. 

Although these situations are rare, they do occur, 

especially in institutions with no protocols for this 

type of clinical procedure. 

Disposable sterile instruments and drapes should 

be used whenever possible, as the majority of the 

debrided wounds contain a substantial number 

of microbes. Special procedure sets, including 

drapes, gauze and disposable instruments, have 

been designed for sharp excision or surgical 

debridement, and are widely available on the 

market, supplied by various producers.

Administration

Pain is a very important issue in the treatment 

of wounds, as such possible pain increase during 

the procedures should be monitored closely. 

Appropriate anaesthesia is essential in all types 

of debridement. Some wounds are painless 

(for example diabetic foot ulcers {neuropathy}, 

frostbite and some pressure ulcers); in these 

situations sharp debridement may be performed 

without significant anaesthesia, but the need for 

oral or systemic pain-killers must be considered 

before the procedure. 

Patient fear is also an issue. Any procedure should 

be thoroughly explained to the patient, obtaining 

a written and signed consent form, if needed and 

possible.

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 The patient should be forewarned 

about any manipulations (injection, tracking of 

tissue, application of the tourniquet). Children 

and patients with a low pain threshold should be 

sedated if anaesthesia is contraindicated. 

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