Debridement

  1. Debride devitalized tissue within the wound bed or edge of pressure ulcers when appropriate to the individual's condition and consistent with overall goals of care. (Strength of Evidence = C)
  2. Select the debridement method(s) most appropriate to: the individual's condition; goals of care; ulcer/periulcer status; type, quantity, and location of necrotic tissue; care setting; and professional accessibility/capability. (Strength of Evidence = C)
    Potential methods include sharp/surgical techniques, autolysis, enzymatic debridement, mechanical debridement, and biosurgical debridement (maggot therapy). Refer to the Clinical Practice Guideline for a description of each technique as well as indications and contraindications.
  3. Use mechanical, autolytic, enzymatic, and/or biosurgical methods of debridement when there is no urgent clinical need for drainage or removal of necrotic tissue. (Strength of Evidence = C)
  4. Perform surgical debridement in the presence of advancing cellulitis, crepitus, fluctuance, and/or sepsis secondary to ulcer-related infection. (Strength of Evidence = C)
  5. Sharp/surgical debridement must be performed by specially trained, competent, qualified, and licensed healthcare professionals consistent with local legal and regulatory statutes. (Strength of Evidence = C)
  6. Use sterile instruments to sharply/surgically debride. (Strength of Evidence = C)
  7. Use sharp debridement with caution in the presence of: immune incompetence, compromised vascular supply to the limb, or lack of antibacterial coverage in systemic sepsis. Relative contraindications include anticoagulant therapy and bleeding disorders. (Strength of Evidence = C)
  8. Refer individuals with Category/Stage III or IV pressure ulcers with undermining, tunneling, sinus tracts, and/or extensive necrotic tissue that cannot be easily removed by other debridement methods for surgical evaluation as is appropriate with the individual's condition and goals of care. (Strength of Evidence = C)
  9. Manage pain associated with debridement. (Strength of Evidence = C)
  10. Perform a thorough vascular assessment prior to debridement of lower extremity pressure ulcers (e.g., rule out arterial insufficiency). (Strength of Evidence = C)
  11. Do not debride stable, hard, dry eschar in ischemic limbs. (Strength of Evidence = C)
    1. Assess wound daily for signs of erythema, tenderness, edema, purulence, fluctuance, crepitance, and/or mal-odor (i.e., signs of infection). (Strength of Evidence = C)
    2. Consult a vascular surgeon urgently in the presence of the above symptoms. (Strength of Evidence = C)
    3. Debride urgently in the presence of the above symptoms if consistent with the individual's wishes and overall goals of care. (Strength of Evidence = C)
  12. Perform maintenance debridement on a chronic pressure ulcer until the wound bed is covered with granulation tissue and free of necrotic tissue. (Strength of Evidence = C)