Debridement of Chronic Wounds

Another important aspect of chronic wounds, which makes them different from acute wounds in the context of wound bed preparation, is the possible need for a "maintenance debridement" phase. Somehow, we have always thought of debridement, whether it be done by surgical, enzymatic, or autolytic means, as a procedure or a therapeutic step with defined time frames. That may be true of acute wounds that have become colonized and necrotic, and thus need to be revitalized. However, with chronic wounds, we are generally unable to fully remove the underlying pathogenic abnormalities; necrotic material, non-viable tissue, exudate, i.e., the necrotic burden continues to accumulate. This notion of an initial debridement phase followed by a maintenance debridement phase is one that we should seriously study and consider adopting within the context of wound bed preparation. It might very well be that we have not paid enough attention to this problem. For example, clinicians will agree that, after initial debridement of chronic wounds, one may observe a temporary positive outcome on wound closure. However, there is often a healing arrest, with a return to a poor wound bed. One explanation is that, because of the underlying and uncorrected pathogenic abnormalities, there is continued accumulation of necrotic tissue and exudate which now cause the healing arrest. Rather than always starting from the beginning, with therefore periodic debridement and exudate control, one might consider a steady state removal of the necrotic burden that should go on throughout the life of the wound.

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