1. Surgical or sharp debridement involves using scalpels, curettes, or scissors to cut away dead, devitalized, or contaminated tissue. It is the fastest way to debride a wound, but it is also the most painful, thus requiring the use of local or general anesthesia. It also requires a skilled doctor. It can be done on most wounds and can be done selectively, minimizing impact to nearby tissue and organs. This type of debridement carries the risk of bleeding and infection as well as loss of tissue.
2. Autolytic debridement involves using the body’s own enzymes and moisture to re-hydrate, soften, and finally liquefy hardened dead tissue. Wound dressings that maintain a moist wound bed are used to create an optimal environment for this process. This method is easy to perform, does not damage healthy tissue, and causes minimal pain. Healing takes weeks to months.
3. Enzymatic debridement is the most selective method of wound debridement. It involves applying naturally occurring enzymes that are manufactured to the wound to work alongside the body’s own enzymes. (Debriding agents available nowadays include bacterial collagenase, papain/urea, and fibrinolysin/ deoxyribonuclease (DNAse). This method can irritate surrounding tissue and is slow to work, but is easy to carry out and may be used in combination with other methods.
4. Mechanical debridement involves physically removing dead tissue and debris from the wound. One way is by using wet-to-dry dressings. A moist dressing is placed over the wound. When it is dry it is lifted off, taking away dead tissue with it. Other methods include flushing the wound with sterile solution, whirlpool baths for powered irrigate to loosen and remove dead tissue and debris, and high-pressure water applied directly to the wound. Some of these can be painful and drive bacteria into soft tissue as well as injure surrounding tissue. This method is not recommended for fragile tissue. It is easy to perform and works faster than autolytic debridement, but can still take some time.
5. Biosurgery or maggot therapy involves placing a number of small maggots, usually the larvae of the green bottle fly, on the wound so they consume the dead tissue. This method is more precise than surgical debridement. This method takes a day or two. Some patients complain of increased pain after the procedure and the psychological effects of the method must also be considered.