Treating Pressure Injuries: Debridement

Cross section of skin showing pressure ulcer with scar material in center. Arrow is going through scar tissue showing part of tissue being removed.

The goal of treatment for pressure injuries is to create a healing environment. This may require debridement (removing dead tissue) so new cells can form. Various types of debridement are available. These are done by doctors and certified specialists. To control pain, the doctor may use pain relieving medicines.

Sharp debridement removes dead tissue with a scalpel, scissors, or other sharp instrument. Extensive removal may require surgery. Sharp debridement allows for precise removal of tissue and is the preferred method if you have an active infection. This technique can be painful.

Enzymatic debridement uses topical agents containing enzymes to dissolve dead tissue. They attack the fibrin and collagen of necrotic tissue and exudate. If eschar is present, tiny cuts may need to be made before applying the enzymes to help ensure their absorption. This “cross-hatching” is done by a doctor or specialist.

Autolytic debridement uses the body’s own enzymes to break down necrotic tissue. Special dressings are used to keep the wound moist, allowing the necrotic skin to slowly separate from healthy tissue. Autolytic debridement can take up to several weeks, but is less painful than other methods. It’s also selective in the tissue it removes. Autolytic debridement should not be used if you have an active infection.

Biosurgical debridement uses sterile larvae (maggots) which produce powerful enzymes that liquify and then ingest dead tissue.

Mechanical (wet-to-dry) debridement may be used to remove debris and dead tissue. It involves applying a piece of gauze moistened with saline to the wound and letting it dry. The dried gauze is then removed, taking tissue and debris with it. This is not a favored method because it may remove healthy tissue as well as dead tissue. Wet-to-dry debridement can also be quite painful.