Med-Surg · chapter 28 · Inflammation and Healing
Debridement
The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 3 practice questions with the reasoning.
Key points
Necrotic tissue and healing
A wound cannot heal in the presence of necrotic or nonviable tissue.
Necrotic tissue barrier
Necrotic tissue creates a physical barrier that prevents the cell migration that facilitates wound healing and acts as a medium for bacterial growth and infection.
Nurse tissue assessment
As tissue dies, it changes color, consistency, and adherence to the wound bed. It is critical for the nurse to both recognize and differentiate necrotic tissues from healing tissue.
Debridement purpose
The debridement process removes foreign debris, necrotic tissue, and bacteria from the wound’s surface.
Slough and purulence
Slough should not be used interchangeably with purulence, which is a sign of infection.
Unstable eschar
If the eschar texture or appearance becomes unstable, then it should be debrided. Unstable eschar appears wet, boggy, loose, or draining, and it can be erythematous.
Debridement method selection
Selecting a debridement method is based on the appearance of the wound bed, wound type, amount of necrotic tissue, patient condition, and care setting.
Autolytic moisture requirement
Autolytic debridement requires a moist environment, as this technique induces the softening—and, eventually, separation—of the necrotic tissues.
Maggot therapy action
The success of maggot therapy is due to the secretion by the maggots of proteolytic enzymes, which break down the necrotic tissue. The maggots then ingest the liquified tissue.
Enzymatic debridement prescription
Currently in the United States, SANTYL ointment is the only FDA-approved enzymatic debriding agent; it requires a prescription for use.
Surgical debridement provider
Surgical debridement should be performed by a skilled, trained, qualified provider who is licensed to provide surgical treatments.
Mechanical debridement selectivity
The procedure is nonselective in that it removes both devitalized tissue debris and viable tissue.
Nurse post-treatment role
The nurse’s role can also include monitoring and evaluating the wound post-treatment, assessing and treating pain, providing emotional support, and facilitating dressing changes.
Dry stable eschar
As a critical rule, it cannot be overstated that debridement is inappropriate if there is dry, stable eschar present, such as in unstageable pressure injuries with no overt signs of infection. In these instances, the dry eschar acts as a natural covering.
Terms to know
- senescent cell
- A senescent cell is a nonfunctioning cell that has stopped dividing but has not died.
- slough
- The yellow or tan fibrin that typically lies on top of the wound bed is called slough.
- eschar
- Necrotic tissue that is brown, black, or tan in appearance is known as eschar.
- autolytic debridement
- The most conservative type of debridement, called autolytic debridement, is the process of using the body’s intrinsic debriding mechanism to remove nonviable tissue.
- biological debridement
- The process of biological debridement, also known as maggot larval therapy (MT), uses sterile larvae of the Lucilia sericata species of the green bottle fly.
- enzymatic debridement
- The process of enzymatic debridement, also known as chemical debridement, is a selective method that uses an exogenous enzyme known as collagenase.
- surgical debridement
- The process of surgical debridement, also known as sharp debridement, involves the use of a scalpel, forceps, curette, scissors, or other instruments to remove necrotic tissue from the wound base.
- mechanical debridement
- The process of mechanical debridement is a nonselective type of debridement in which physical force is applied to remove necrotic tissue.
Practice questions
Stuck on select-all-that-apply? How to take them one option at a time.
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Every question here, with the answer
At 0900, you assess a heel wound with dry, adherent eschar and no cracking, redness, or other signs of infection. Which assessment-and-plan entry best reflects these findings?
- Dry, adherent heel eschar without redness; soften with autolytic debridement to remove the necrotic barrier.
- Dry, stable heel eschar without cracking or redness; retain intact as a natural covering.
- Dry, adherent heel eschar without infection; debridement is indicated because the tissue is nonviable.
- Dry, adherent heel scab without cracking; covering represents coagulated blood or exudate.
Answer: Dry, stable heel eschar without cracking or redness; retain intact as a natural covering.
Stable, intact heel eschar should remain in place because it serves as a natural barrier to infection. The debridement entries overlook this exception to removing nonviable tissue, while the scab entry incorrectly equates eschar with coagulated blood or exudate.
At 1000, you are documenting the rationale for an autolytic debridement plan for a noninfected wound with dry necrotic tissue. Which product-and-purpose statements are appropriate for this plan? Select all that apply.
- Medicinal honey to donate moisture and support autolytic debridement.
- Collagenase ointment to provide debridement through the body's intrinsic enzymes.
- Hydrocolloid dressing as the preferred autolytic dressing for dry necrotic tissue.
- Foam dressing as the preferred autolytic dressing for dry necrotic tissue.
- Hydrogel to donate moisture and support autolytic debridement.
Answer: Medicinal honey to donate moisture and support autolytic debridement., Hydrogel to donate moisture and support autolytic debridement.
Hydrogels and medicinal honey donate the moisture needed to support autolytic debridement of dry necrotic tissue. The section recommends foam or hydrocolloid dressings when tissue is already moist. Collagenase is an exogenous enzyme used for enzymatic debridement, not the body's intrinsic autolytic mechanism.
At 1400, you review a wound plan that proposes autolytic debridement. The wound requires an immediate and significant decrease in necrotic tissue. Which assessment-and-plan entry best matches the section?
- Autolytic debridement appropriate because it is highly selective and affects only necrotic tissue.
- Continue autolytic debridement; reassess only after the necrotic tissue has fully separated.
- Autolytic debridement takes several days to work; consider a different debridement modality.
- Autolytic debridement appropriate because it is the most conservative type of debridement.
Answer: Autolytic debridement takes several days to work; consider a different debridement modality.
The section describes autolysis as a slow process that takes several days, and states that when a wound requires an immediate and significant decrease in necrotic tissue, a different modality should be considered. Being selective and conservative are true features of autolytic debridement, but they do not address the need for speed, and waiting for full separation delays the removal the wound needs.
Where every quote comes from
Section 28.4 Debridement of Medical-Surgical Nursing by Christy Bowen, Bridget Carey, Jessica Palozie, Maren Reinholdt, OpenStax, 2024. Read the whole section free at openstax.org.
The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.