Wound Debridement: The process of debridement reduces wound contamination and facilitates the wound healing process.
Necrotic tissue is dead tissue, which usually results from an inadequate local blood supply. Necrotic tissue contains dead cells and debris that are a consequence of the fragmentation of dying cells. Necrotic tissue changes color from red to yellow/brown or black/purple, as it becomes more dehydrated. Finally, it forms a black, dry, thick, and leathery structure known as eschar. This can be seen in a wide variety of wound types.
The removal of necrotic tissue by debridement is of great importance for a number of reasons:
- Devitalized (dead) tissue inside the wound will reduce the ability of the clinician to adequately assess the depth of the wound or the condition of the surrounding tissue.
- Concealed dead spaces could harbor bacteria and increase the risk of local infection. Secondly, necrotic tissue may also mask signs of local wound infection.
- The presence of necrotic tissue is a physical barrier to healing and supports significant bacterial growth. Bacterial colonies, which are often present in necrotic tissue, can produce damaging proteases, which break down important constituents of the extracellular matrix and have a negative effect on the formation of granulation tissue and re-epithelialization.
Surgical (excisional) debridement is the fastest way to remove debris and necrotic tissue from the wound bed. Other than being an efficient method, surgical debridement causes minimal damage to surrounding tissue, and minor bleeding following the procedure can release inflammatory mediators, such as cytokines, as well as growth factors that can assist the wound repair process.