Wound care
Advancing wound debridement practice
Tissue viability experts Elizabeth Williams, Andrew Kerr and Sarah Waller examine the evolution of debridement, highlighting its clinical significance, the growing need for a patient-centred approach, and the latest advances.
Historical records suggest that debridement practices have ancient origins, with Egyptian medical texts dating as far back as 1400 BC, describing the removal of necrotic tissue to promote wound healing.1
Despite this early
recognition, a significant shift in wound care principles did not occur until the late 19th century. The 1880s marked a turning point in the systematic understanding and implementation of wound care protocols. At this time, medical literature introduced structured approaches to wound cleansing, mechanical removal of debris, and the application of antiseptic agents.2 Notably, the use of carbolic acid as one of the first antiseptic irrigation solutions represented a major advancement in infection control and wound bed preparation. This period also marked the emergence of the term “debridement” as a defined clinical concept, a transformative shift in wound care that laid the foundation for more effective and hygienic treatment practices.2
The recognition of debridement
during this era signified a paradigm shift in wound management, fundamentally changing approaches to wound treatment. This concept introduced a more methodical, hygienic, and efficacious approach to wound care, influencing both clinical practice and future innovation.
Integral debridement: a patient centred approach Debridement continues to serve as a cornerstone of effective wound management, playing a critical role in preparing the wound bed for healing. The 2024 International Consensus Document defines it as “the removal of viable and non-viable wound components, including necrotic tissue, slough, microorganisms, biofilm, extracellular polymeric substances (EPS), and foreign materials”.3
Its primary goal is to clear the
wound bed of non-viable tissue and contaminants using the most effective methods with minimal adverse effects. When performed safely and appropriately, debridement yields several clinical benefits. It enhances microvascular perfusion, reduces inflammation and protease activity, and
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supports epithelialisation and wound margin regeneration.3,4,5
Additionally, it helps control
malodour, reduces infection risk, improves diagnostic visibility and ultimately enhancing patient quality of life.4,5
Beyond localised wound
effects, debridement creates an optimal environment for healing, promoting healthy tissue growth and improves the efficacy of subsequent wound therapies.6
Over time, numerous
debridement methods have evolved. However, the classification system from the 2013 European Wound Management Association (EWMA) consensus is now considered outdated and inconsistently applied,3
potentially complicating
clinical decision making and product selection. The 2024 International Consensus Document introduces a modern framework labelled integral debridement. This highlights the importance of selecting debridement methods tailored to each patient’s specific needs. The model considers individual patient needs, preferences, care settings, provider competencies, and resource availability. It also recognises that some debridement
methods may be unsuitable in certain situations due to variations in training or scope of practice. Ultimately, the selection of a debridement method should be guided by clinical judgment, patient-specific factors, and the clinician’s competence to safely implement the chosen technique at the point of care.3
Approaches to wound debridement Conservative sharp debridement (also referred to as selective debridement) and surgical debridement are widely regarded as the gold standards due to their proven clinical effectiveness.3
application requires practitioners to possess a comprehensive skill set, including in depth anatomical knowledge, technical proficiency, sound clinical judgment and a professional approach to practice.3,7
patient populations, such as those receiving anticoagulant therapy, individuals who are immunocompromised, or cases involving exposed bone or tendons, sharp or surgical
However, their safe and effective
Furthermore, in certain
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