Safe debridement in the community

Amount of tissue to be debrided

A factor that will influence the choice 

of debridement method is the amount 

of non-viable tissue to be removed. 

If a large amount of non-viable tissue 

is present, serial debridement may 

be indicated. However, if the non-

viable tissue is placing the individual 

at risk of a systemic infection, the 

consequences of not immediately 

debriding the tissue may be 

catastrophic and an urgent surgical 

referral is necessary (Young, 2011).

Hyperkeratosis

Hyperkeratosis is the presence of dry 

scales found on the surrounding skin 

of patients with venous leg ulcers. 

A common way of removing this is 

soaking the leg in a bucket of water 

containing an emollient, followed by the 

application of a variety of treatments, 

including paste bandages, hydrocolloid 

dressings and wiping with gauze. The 

time taken to complete this procedure 

can range from 10–30 minutes. 

The disadvantages of these methods 

are the time taken to complete the 

procedure and the potential for 

cross infection and trauma. There 

is no standard practice for dealing 

with hyperkeratosis and the current 

methods are not ideal, therefore, there 

is the potential to develop a more 

patient and nurse-friendly method of 

de-scaling the legs (Young, 2011).

Clinicians cannot assess a wound 

properly until they have removed all 

necrotic devitalised tissue (Haycocks 

and Chadwick, 2012). This is extremely 

important in tissue viability when 

trying to accurately establish the stage/

category of pressure ulcers (Stephen-

Haynes and Callaghan, 2012).

Method

A clear understanding of the need 

for debridement and available 

options is necessary for the 

clinician to be able to make the 

appropriate choice of debridement 

technique. 

Unlike acute wounds, which usually 

only require debridement once if 

at all, chronic wounds may require 

repeated maintenance debridement  

(EWMA, 2004).

Therefore, the choice of debridement 

technique is a risk assessment process 

that takes into account the following 

factors:

8 

Safety 

8 

Patient choice

8 

The amount of devitalised tissue 

to be removed

8 

The environment in which the 

debridement will be undertaken

8 

The availability of debriding 

equipment 

8 

The time/speed that is required to 

remove the devitalised tissue

8 

The pain caused during the 

debridement process

8 

The skill and knowledge of 

the person undertaking the 

debridement (Young, 2011).

The practitioner, in conjunction 

with the patient, should set short- 

and long-term objectives for the 

debridement process. The setting of 

debridement objectives should lead 

to the development of a debridement 

treatment plan (Gray et al, 2011).