Patient education: Debridement of a wound or burn (The Basics)

What is debridement? — 

This is when a doctor removes dead or injured tissue from a wound.

A wound can happen in different ways. For example, the skin gets injured if you get an accidental cut or scrape, have surgery, or get a burn. When the skin is injured:

●It can become infected.

●Parts of the skin and surrounding tissue can die.

●Small objects can get stuck in it – For example, if you fall on gravel and some gets stuck in your skin.

Debridement involves removing the affected skin, and anything stuck in it, to help it heal. This might be done at the doctor's office or in an operating room.

There are different ways to debride a wound. These include:

●Flushing the affected skin with plain or salt water

●Applying an ointment containing "enzymes" – Enzymes are proteins that help break down and remove dead tissue.

●Brushing or scraping the area with gauze or a special brush

●Removing the affected tissue by cutting it out with a scalpel, scissors, or a tool with a sharp loop on the end

The doctors might use sterile maggots to clean out the wound. Since many people are uncomfortable with this, it is less common. But it is safe and effective.

The type of debridement you need depends on the kind of wound you have and how severe it is. If your wound is taking longer than expected to heal, it is called a "chronic wound." The doctor might need to debride a chronic wound several times over weeks to months.

How do I prepare for debridement? — 

The doctor or nurse will tell you if you need to do anything special to prepare. Before your procedure, your doctor will do an exam. They might send you to get tests, such as:

●Imaging tests, like X-ray, ultrasound, CT scan, and MRI – These create pictures of the inside of the body. They can help your doctor figure out if you need any other treatment.

●Wound culture – This is when the doctor takes a sample of cells from inside or near your wound. Then, they test it to check for germs. Knowing what type of germ is causing the infection helps them figure out how best to treat it.

●Blood culture – This is when the doctor takes a sample of blood to check for germs. This might be done if you have symptoms of worsening infection, like the skin around the wound changing color, a high fever, or chills.

●Other blood tests – These can help the doctor decide if you need extra nutrients before or after debridement.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

●Any recent changes to your weight – This can help your doctor decide if you need any extra nutrients.

You will also get information about:

●Eating and drinking before your procedure – You might need to "fast" before surgery. This means not eating or drinking anything for a period of time. Or you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●Lowering the risk of infection – You might need to trim (not shave) your body hair before the procedure. You might also need to wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during debridement? — 

When it is time for the procedure:

●You might get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You might get medicines to help control pain during or after the procedure. These might include anesthesia medicines. Types of anesthesia include:

•Local – This type uses medicine to numb a small part of your body so you don't feel pain.

•Regional – This type blocks pain in 1 area of your body, such as an arm, a leg, or the lower half of your body. You might be awake. Or you might get medicines to make you relax and feel sleepy, called "sedatives."

•General – This type makes you unconscious so you can't feel, see, or hear anything during the procedure. You might get a breathing tube to help you breathe.

●If you get regional or general anesthesia, the doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●If your wound is from a recent burn, the staff will cool the area. They might soak the area or apply cool, wet dressings.

●The staff will clean your skin. They will also remove any stitches, staples, or glue on the wound.

●The doctor will remove any dead tissue or anything stuck in the wound.

●It is common for debridement to make your skin bleed. If this happens, the doctor or nurse will use gentle pressure or medicines to stop the bleeding.

●If the doctor thinks the wound could be infected, they will take a small sample for testing.

●They might apply medicine to your skin to help with healing and infection.

●They might close the wound with stitches or staples. Some wounds do not need to be closed. Others need to be left open to heal.

●The doctor will cover your wound with clean bandages. Some wounds need extra help with healing. Your doctor might use special dressings, such as:

•"Packing" – This involves putting gauze or other special material into the wound. The packing material helps absorb drainage if the wound is wet, or helps provide moisture if the wound is dried out. It also helps keep it clean as it heals.

•"Negative pressure wound therapy" – This uses thin tubing to connect a special kind of dressing to a machine. The machine creates a suction or vacuum to pull fluid out of the wound. It also affects the surface of the wound to help it heal. The suction can be on all the time, or can be set to go on and off at certain times.

●The procedure will take 10 minutes to 1 hour.

The doctor might do other procedures after they debride the wound. For example, they might do a "skin graft" or "skin flap" to replace damaged skin.

What happens after debridement? — 

If you had regional or general anesthesia, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine if needed to help with pain. You might need other medicines, too.

●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

●The doctor or nurse will tell you how to take care of the wound.

If your debridement was done in an office or clinic, you can go home the same day.

What are the risks of debridement? — 

Your doctor will talk to you about all the possible risks and answer your questions. Possible risks include:

●Bleeding

●Infection

●Scarring

●Nerve damage

What else should I know? — 

Before you go home from the hospital, make sure you know what problems to look out for and when you should call the doctor. Make sure you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

More on this topic

Patient education: Debridement of a wound or burn – Discharge instructions (The Basics)
Patient education: Bacterial wound culture (The Basics)
Patient education: Negative pressure wound therapy (The Basics)
Patient education: Anesthesia in adults (The Basics)
Patient education: Stitches and staples (The Basics)
Patient education: Taking care of cuts, scrapes, and puncture wounds (The Basics)
Patient education: Lowering the risk of a surgical site infection (The Basics)
Patient education: Caring for an open surgical wound (The Basics)
Patient education: Caring for a closed surgical wound (The Basics)
Patient education: How to change a dressing (The Basics)