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Sharp debridement

Discussion in 'General Issues and Discussion Forum' started by todaytoday, Aug 6, 2014.

  1. todaytoday

    todaytoday Welcome New Poster

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    I feel silly to really ask but there is a terminology issue I can't pin down an answer to online. How does sharp debridement that we do with a scalpel in our clinic sit in the heirachy of definition of debridement? Is it considered "surgical debridement" even though it is in a clinical setting? I'm just silly student with an elementary question.

    i.e. is this correct? Types of debridement:
    1 Sharp debridement
    -Clinical/bedside (involves scalpel but can sometimes use Versajet which used to be used surgically only) (podiatrist)
    -Surgical debridement +/- GA, etc. (using forceps, tissue nippers, can also use a scalpel common to clinical aforementioned)
    2 Mechanical debridement
    -pressurised irrigation sprays, syringes or catheters
    -used to mean using wettodry dressings (no longer indicated)
    3 Autolytic debridement
    -through dressings
    4 Chemical debridement
    -makes use of certain enzymes and other compounds to dissolve necrotic tissue. It is more selective than mechanical debridement. In fact, the body makes its own enzyme, collagenase, to break down collagen, one of the major building blocks of skin. A pharmaceutical version of collagenase is available and is highly effective as a debridement agent. As with other debridement techniques, the area first is flushed with saline. Any crust of dead tissue is etched in a crosshatched pattern to allow the enzyme to penetrate. A topical antibiotic is also applied to prevent introducing infection into the bloodstream. A moist dressing is then placed over the wound.
    5 Biological debridement
    -maggot therapy
  2. cmatt

    cmatt Member

    That sounds about right, though in the Cochrane review of the debridement of diabetic foot ulcers (Edwards and Stapley 2010) they class sharp debridement as mechanical as they only classify methods as mechanical and non-mechanical. They classify debridement methods as follows:

    Surgical (sharp with scalpel)
    Bio-Surgery (Maggots)

    Enzyme preparations
    Polysaccharide beads or paste dextranomer polysaccharide

    With regards to the surgical/clinical debridement- Attinger et al. (2010) describe both office/clinic-based and theatre-based sharp debridement as surgical debridement. The only real difference seems to be the depth of the tissue that can be debrided safely.

    I'm not sure how much it matters how you classify them, and I'm not sure the evidence points to a hierarchy in terms of efficacy.

    Edwards J, Stapley S (2010) Debridement of diabetic foot ulcers. Cochrane Database of Systematic Reviews 2010, Issue 1. Available from:

    Attinger CE, Steinberg JS and Meyer AJ (2010) Debridement of the diabetic foot IN: Armstrong DG and Lavery LA (eds) Clinical care of the diabetic foot (2nd Edition) Virginia: American Diabetes Association

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