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 3

Local anaesthesia should be used with caution, as 

the application of anaesthetics (ointments, creams) 

may be insufficient and infiltrate local anaesthesia. 

In particular, vasoconstrictive agents (epinephrine) 

may lead to suppression of local immune protection 

and thus enhance bacterial load and infection.

Benefits

The primary benefit of sharp and surgical 

debridement is the speed of removal of dead 

tissue. These procedures allow fast and effective 

removal, allowing the healing process to start 

immediately. A further benefit of sharp excision 

is the low cost of treatment compared with, for 

example, surgical debridement.

Among the benefits of surgical debridement is that 

it is possible to remove dead tissue when other 

alternative methods are ineffective. This method is 

quick and essential when the presence of devitalised 

tissue becomes life threatening for the patient. 

Another benefit is the possibility to close the wound 

when immediate reconstruction is performed.

There is some documentation available on the 

benefits of surgical debridement with regard to 

increased healing rates, improved status of the 

wound and a reduction in pain related to the 

wound status after the procedure.

105,131–133

Contraindications

Surgical and sharp debridement are non-selective 

methods, bringing the risk of over-excision into 

consideration.

52,134

 Over-excised wounds might heal 

with scarring, lead to a significant delay in healing 

(when debridement is brutal/not gentle), or cause 

damage to the deeper structures may occur. However, 

this is rarely the case for sharp debridement, as this 

method is usually performed with the intention to 

remove small amounts of visible non-viable tissue. 

Considerations and precautions should be taken 

in specific areas, such as temporal areas, neck, 

axilla, groin and other areas where neurovascular 

bundles pass superficially and damage to the vitally 

and functionally important structures (major 

blood vessels, nerves and tendons) may occur. In 

these situations, whenever removal of necrotic 

tissue is indicated, surgical debridement must be 

performed by an experienced specialist. Usually 

these procedures take place in a dedicated facility 

(operating theatre or procedural room) and with 

use of appropriate anaesthesia. 

Although the risk is small, a potential enlargement 

of the wound in the deeper layers must be 

considered and pre-procedural planning and 

proper evaluation must be performed. Pocketing of 

the wound, involving the deep structures (blood 

vessels, nerves, tendons or even bones), may 

require an major procedure, involving removal and 

replacement of the affected structures. 

As sharp and surgical debridement may be very 

invasive procedures, special precautions must be 

taken into account when treating functionally 

and cosmetically important areas, such as the face, 

hands, perineum and feet. Excessive damage of the 

tissue should be avoided and alternative techniques 

should be considered for treatment of these areas.

Contraindications for sharp and surgical 

debridement are few. The most important are 

a poor general state of the patient and the 

disturbance of the blood coagulation. Usually 

these contraindications are relative, as sharp 

debridement is a small intervention that drastically 

improves the patient state in the majority of  

cases, leading to the release of cytokines and 

mediators of the inflammation. Debridement will, 

in all cases, improve the wound healing if over-

debridement is avoided.

However, an absolute contraindication for any 

sharp debridement is refusal from the patient and 

choice of alternative treatment method should be 

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