Safe debridement in the community

Frequently-used methods 

of debridement in the 

community setting

Autolysis

Autolytic debridement will occur 

naturally if a passive stance is taken 

as an individual’s immune system 

will phagocytose the non-viable 

tissue (Ayello et al, 2004). Phagocytic 

cells, such as macrophages and the 

destructive (proteolytic) enzymes in 

the wound bed, liquefy and separate 

necrotic tissue from the wound bed. 

Evidence of the separation is usually 

seen at the wound edges (Figure 1) 

(Haycocks and Chadwick, 2012). 

Figure 1. 

Necrotic heel 

separating at the edges.

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This debris is then cleared either by 

the dressing or by macrophages and 

neutrophils (Hampton, 2011).

Wound dressings, such as hydrogels 

and hydocolloids facilitate the 

autolytic process by providing a 

moist environment at the wound bed 

and externally softening the issue. 

Wet sloughy wounds do not require 

additional moisture and alginate and 

Hydrofiber

®

 (ConvaTec) dressings are 

examples of dressings that are more 

suited to aid autolysis in this situation.

The main advantage of autolytic 

debridement is that it is generally 

painless, however, the major 

disadvantage is the length of time 

needed to achieve the desired result, 

the increased exudate levels as the 

wound debrides and, if not protected, 

the maceration that can occur in the 

periwound skin (Benbow, 2011a,b).

It is important that practitioners 

undertake autolytic debridement 

to achieve the optimal outcome for 

the patient within an acceptable 

timeframe. However, it can be argued 

that this method is commonly chosen 

because of its simplicity, rather than 

to meet the needs of patients. When 

choosing autolytic debridement, 

the practitioner may be confusing 

activity (autolytic debridement) with 

achievement (removing the non-

viable tissue). 

It is important that clinicians question 

whether autolytic debridement will 

result in the removal of the non-

viable tissue in the most efficient 

and timely manner (Young, 2011). 

Also, the perceived safety of this 

method must be balanced with the 

risk to the patient of not removing 

the non-viable tissue quickly enough, 

which could lead to infection and 

an extended period of malodour 

and exudate as the non-viable tissue 

slowly debrides.