Debridement Health Article

Biological debridement

Maggot therapy is a form of biological debridement known since antiquity. The larvae of Lucilia sericata (greenbottle fly) are applied to the wound as these organisms can digest necrotic tissue and pathogenic bacteria. The method is rapid and selective, although patients are usually reluctant to submit to the procedure.

Diagnosis/Preparation

The physician or nurse will begin by assessing the need for debridement. The wound will be examined, frequently by inserting a gloved finger into the wound to estimate the depth of dead tissue and evaluate whether it lies close to other organs, bone, or important body features. The assessment addresses the following points:

• the nature of the necrotic or ischaemic tissue and the best debridement procedure to follow
• the risk of spreading infection and the use of antibiotics
• the presence of underlying medical conditions causing the wound
• the extent of ischaemia in the wound tissues
• the location of the wound in the body
• the type of pain management to be used during the procedure

Before surgical or mechanical debridement, the area may be flushed with a saline solution, and an antalgic cream or injection may be applied. If the antalgic cream is used, it is usually applied over the exposed area some 90 minutes before the procedure.

Aftercare

After surgical debridement, the wound is usually packed with a dry dressing for a day to control bleeding. Afterward, moist dressings are applied to promote wound healing. Moist dressings are also used after mechanical, chemical, and autolytic debridement. Many factors contribute to wound healing, which frequently can take considerable time. Debridement may need to be repeated.