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((short description|Medical removal of dead, damaged, or infected tissue))
((for multi|cleaning of teeth|Debridement (dental)|the drug marketed under the name ''Debridat''|Trimebutine))
((refimprove|date=May 2013))
((Use dmy dates|date=March 2015))
((Infobox medical intervention
|  Name        = Debridement
| pronounce    = ((IPAc-en|d|ᵻ|ˈ|b|r|iː|d|m|ə|n|t))<ref>((cite web |url=http://www.merriam-webster.com/dictionary/debridement |title=Merriam-Webster Dictionary |website=merriam-webster.com))</ref>
|  Image       = Necrotizing fasciitis left leg debridement.JPEG
|  Caption     = [[Necrosis|Necrotic tissue]] from the left leg is being surgically debrided in a patient with [[necrotizing fasciitis]]. 
|  ICD10       = 0?D
|  ICD9        =
|  ICD9_mult   =
|  MeshID      = D003646
|  OPS301      =
|  OtherCodes  =
))

'''Debridement''' is the medical removal of [[dead]], damaged, or [[infect]]ed [[tissue (biology)|tissue]] to improve the healing potential of the remaining [[health]]y tissue.<ref>((cite web |url=http://www.merriam-webster.com/dictionary/debridement |title= debridement |website=merriam-webster.com |access-date=5 September 2013))</ref><ref>((Cite news|url=https://www.healthnmedicare.com/debridement/|title=Understand Debridement Before You Regret – Why you Need Debridement|date=2018-03-24|work=HealthNmedicarE|access-date=2018-04-08|language=en-US|archive-date=9 April 2018|archive-url=https://web.archive.org/web/20180409044114/https://www.healthnmedicare.com/debridement/|url-status=dead))</ref> Removal may be [[surgery|surgical]], mechanical, chemical, [[Autolysis (biology)|autolytic]] (self-digestion), and by [[maggot therapy]].

In [[podiatry]], practitioners such as [[chiropodists]], [[podiatrists]] and [[foot health practitioner]]s remove conditions such as [[callus]]es and [[verrucas]].

Debridement is an important part of the healing process for [[burn]]s and other serious wounds; it is also used for treating some kinds of snake and spider bites.

Sometimes the boundaries of the problem tissue may not be clearly defined. For example, when excising a tumor, there may be [[micrometastasis|micrometastases]] along the edges of the tumor that are too small to be detected, but if not removed, could cause a relapse. In such circumstances, a surgeon may opt to debride a portion of the surrounding healthy tissue to ensure that the tumor is completely removed.

== Types ==
There is lack of high quality evidence to compare the effectiveness of various debridement methods on time taken for debridement or time taken for complete healing of wounds.<ref>((Cite journal|last1=Smith|first1=Fiona|last2=Dryburgh|first2=Nancy|last3=Donaldson|first3=Jayne|last4=Mitchell|first4=Melloney|date=2013-09-05|editor-last=Cochrane Wounds Group|title=Debridement for surgical wounds|journal=Cochrane Database of Systematic Reviews|volume=2013 |issue=9|pages=CD006214|language=en|doi=10.1002/14651858.CD006214.pub4|pmid=24008995|pmc=7389652|hdl=1893/20573|hdl-access=free))</ref>

=== Surgical debridement ===
Surgical or "sharp" debridement and laser debridement under anesthesia are the fastest methods of debridement. They are very selective, meaning that the person performing the debridement has complete control over which tissue is removed and which is left behind.
Surgical debridement can be performed in the operating room or bedside, depending on the extent of the necrotic material and a patient's ability to tolerate the procedure.
The surgeon will typically debride tissue back to viability, as determined by tissue appearance and the presence of blood flow in healthy tissue.<ref>((cite journal|last1=Hakkarainen|first1=TW|last2=Kopari|first2=NM|last3=Pham|first3=TN|last4=Evans|first4=HL|title=Necrotizing soft tissue infections: review and current concepts in treatment, systems of care, and outcomes|journal=Current Problems in Surgery|date=August 2014|volume=51|issue=8|pages=344–62|pmid=25069713|doi=10.1067/j.cpsurg.2014.06.001|pmc=4199388))</ref>

=== Autolytic debridement ===
[[Autolysis (biology)|Autolysis]] uses the body's own enzymes and moisture to re-hydrate, soften and finally liquefy hard [[eschar]] and [[sloughing|slough]]. Autolytic debridement is selective; only [[necrotic tissue]] is liquefied. It is also virtually painless for the patient. Autolytic debridement can be achieved with the use of occlusive or semi-occlusive dressings which maintain wound fluid in contact with the necrotic tissue. Autolytic debridement can be achieved with [[hydrocolloids]], [[hydrogels]] and transparent films. It is suitable for wounds where the amount of dead tissue is not extensive and where there is no infection.<ref name="Wound Practice 2013">((Cite journal |last=Wound Healing and Management Node Group |date=June 2013 |title=Wound Management: Debridement - Autolytic |url=http://www.woundsaustralia.com.au/journal/2102_10.pdf |journal=Wound Practice and Research |volume=21 |issue=2 |pages=94–95 |access-date=8 September 2017 |archive-date=1 March 2017 |archive-url=https://web.archive.org/web/20170301021426/http://www.woundsaustralia.com.au/journal/2102_10.pdf |url-status=dead ))</ref>

=== Enzymatic debridement ===
Chemical enzymes are fast acting products that slough off necrotic tissue. These enzymes are derived from micro-organisms including ''[[Clostridium histolyticum]]''; or from plants, examples include [[collagenase]], [[varidase]], [[papain]], and [[bromelain]]. Some of these enzymatic debriders are selective, while some are not. This method works well on wounds (especially burns) with a large amount of necrotic debris or with [[eschar]] formation. However, the results are mixed and the effectiveness is variable. Therefore, this type of debridement is used sparingly and is not considered a standard of care for burn treatments.<ref>((cite journal |last1=Langer |first1=Vijay |last2=Bhandari |first2=P.S. |last3=Rajagopalan |first3=S. |last4=Mukherjee |first4=M.K. |title=Enzymatic debridement of large burn wounds with papain–urea: Is it safe? |journal=[[Medical Journal Armed Forces India]] |volume=69 |issue=2 |pages=144–50 |year=2013 |pmid=24600088 |pmc=3862849 |doi=10.1016/j.mjafi.2012.09.001 ))</ref>

=== Mechanical debridement ===
When removal of [[Tissue (biology)|tissue]] is necessary for the treatment of wounds, [[hydrotherapy]] which performs selective mechanical debridement can be used.<ref name="APTAfive">((cite press release |title=Choosing Wisely Five Things Physicians and Patients Should Question |publisher=[[ABIM Foundation]] |date=April 4, 2012 |url=http://www.choosingwisely.org/choosing-wisely-five-things-physicians-and-patients-should-question-press-release-april-4-2012/ |access-date=April 7, 2016 ))</ref> Examples of this include directed wound irrigation and [[therapeutic irrigation]] with suction.<ref name="APTAfive"/> Baths with [[whirlpool]] water flow should not be used to manage wounds because a whirlpool will not selectively target the tissue to be removed and can damage all tissue.<ref name="APTAfive"/> Whirlpools also create an unwanted risk of bacterial infection, can damage fragile body tissue, and in the case of treating arms and legs, bring risk of [[Complication (medicine)|complications]] from [[edema]].<ref name="APTAfive"/>

Hydrosurgery uses a high‐pressure, water‐based jet system to remove burnt skin. This should leave behind the unburned, healthy skin. A 2019 [[Cochrane (organisation)|Cochrane]] [[systematic review]] aimed to find out if burns treated with hydrosurgery heal more quickly and with fewer infections than burns treated with a knife. The review authors only found one [[Randomized controlled trial|randomised controlled trial]] (RCT) with very low certainty evidence that investigated this. Based on this trial, they concluded that it is uncertain whether or not hydrosurgery is better than conventional surgery for early treatment of mid‐depth burns. More RCTs are needed to fully answer this question.<ref>((Cite journal|last1=Wormald|first1=Justin CR|last2=Wade|first2=Ryckie G|last3=Dunne|first3=Jonathan A|last4=Collins|first4=Declan P|last5=Jain|first5=Abhilash|date=2020-09-03|title=Hydrosurgical debridement versus conventional surgical debridement for acute partial-thickness burns|url=https://doi.org/10.1002/14651858.CD012826.pub2|journal=Cochrane Database of Systematic Reviews|volume=2020|issue=9|pages=CD012826|doi=10.1002/14651858.cd012826.pub2|pmid=32882071|pmc=8094409|issn=1465-1858))</ref>

Allowing a dressing to proceed from moist to dry, then manually removing the dressing causes a form of non-selective debridement. This method works best on wounds with moderate amounts of necrotic debris (e.g. "dead tissue").((citation needed|date=April 2016))
[[File:Maggot debridement therapy on a diabetic foot.jpg|thumb|267x267px|Maggot debridement being used on a diabetic foot ulcer.]]

=== Maggot therapy ===
In [[maggot therapy]], a number of small maggots are introduced to a wound in order to consume necrotic tissue, and do so far more precisely than is possible in a normal surgical operation. Larvae of the [[green bottle fly]] (''Lucilia sericata'') are used, which primarily feed on the necrotic (dead) tissue of the living host without attacking living tissue. Maggots can debride a wound in one or two days.  The maggots derive nutrients through a process known as "extracorporeal digestion" by secreting a broad spectrum of proteolytic enzymes that liquefy necrotic tissue, and absorb the semi-liquid result within a few days. In an optimum wound environment maggots molt twice, increasing in length from 1–2&nbsp;mm to 8–10&nbsp;mm, and in girth, within a period of 3–4 days by ingesting necrotic tissue, leaving a clean wound free of necrotic tissue when they are removed.

==See also==
((Portal|Medicine))
* [[Exfoliation (cosmetology)]]
* [[Ubi pus, ibi evacua]]

==References==
((reflist))

==External links==
((wiktionary))
* ((Internet Archive short film|id=gov.dod.dimoc.25898|name=A METHOD OF TEACHING COMBAT SURGERY (1958)))

[[Category:Medical treatments]]

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