1. Technique of Sharp Wound Debridement

2. Preparation for debridement:
Physician order for sharp debridement
Developing a strategy: What are the goals? To heal or not to heal? Will all your work be in vain?
Know the patients past and current medical history, wound assessment, vascular status, neurological status, medications
Obtain patient or family consent
Instruments and supplies
Apprehension (yours VS. the patient’s)
Location, location, location

3. Physician order for sharp debridement:
Is the order specific to exactly what needs to be done?
Has the physician seen the wound recently or is this an order called in over the phone?

4. Developing a Strategy: What are the goals. To heal or not to heal
Developing a Strategy: What are the goals? To heal or not to heal? Will all you work be in vain?
To remove necrotic tissue
To reduce bacterial count
To allow granulation to occur
Just keeping the wound clean or do we realistically expect the wound to heal. Dictates treatment plan: expensive Vs. non expensive modalities
You just spent 15 minutes upside down debriding a necrotic plantar foot wound. Your back hurts. You come back next week and look at the patient and find out they’ve participated in Tango lessons for 5 of the last seven days.

5. Know the patients past and current medical history, wound assessment, vascular status, neurological status, medications:
Do not take a sharp instrument to a patient without knowing the above information. It is a poorly planned procedure if you do!

6. Obtain patient or family’s consent
“Sure, go ahead and cut on my mother.”
Informed consent: Explain expectations, risks and benefits

7. Instruments and Supplies
Iris Scissors
Tissue Forceps with and without teeth
Curettes
Hemostat
Rongeur
Scalpel #3 handle with blade #11, #15, #10 disposable
Bandage scissors
Wound measuring device
Camera

8. Instruments and Supplies
Gloves sterile or non sterile
Sterile/clean field i.e. chuck, drape
Syringes and needles
Topical or injectable anesthetic if needed
Gauze
Cotton tipped applicators
Saline
Hemostatic product i.e. Silver nitrate, Surgicel, etc.
Hazardous waste bag -red

11. Tissue Forceps
Rongeur
#10 Blade
Iris Scissors
#15 Blade
Curette
Adson Brown Forceps

12. Curette

13. Basic instruments

14. Adson Brown forceps with teeth

15. Apprehension: Yours Vs. the Patient’s
Know your limitations
How long is the procedure going to last?
If you’re nervous, not confident, or have a gut feeling that something's not right, don’t proceed
Is the patient comfortable, in pain or combative?

16. Location, Location, Location
Patient should be in a comfortable position
You should be in a comfortable position
There should be adequate lighting
Have an assistant if possible
Aseptic field

17. Relax

18. Technique for sharp debridement with a scalpel or scissors
Grasp the eschar or necrotic tissue with a tissue forceps or hemostat
Using a scalpel or scissors, cut underneath staying parallel to the plane of the wound
Be sure to visualize where the tip of the instrument is cutting
Remove the tissue in layers if
unsure of how deep to go

19. Sharp Debridement

20. How much to debride?
Depends on the amount of non viable tissue
How much can the patient tolerate?
It is important to set limits
A bedside debridement should take 5-30 minutes depending on location, amount of tissue removed, patient comfort and clinician fatigue
Rate of debridement will also depend on your experience

21. Following removal of non viable tissue the wound is cleaned with normal saline. Check for any uncontrolled bleeding and perform hemostasis if necessary.
If indicated, take cultures of the wound. Deep tissue cultures/samples are preferred to superficial swab cultures.
The wound is then dressed per orders.
Debridement may have to be daily, weekly or
on a PRN basis.
Physician orders should reflect this.