Why dead skin needs to be removed from a wound?
Open wounds, such as burns and surgical lacerations might be severe enough to damage the skin tissues and thus, result in dead skin tissues around the wound—the necrosis during healing process. The occurrence of this necrosis, however, is non-desirable, as it may interfere the entire healing process and slow it down. To minimize inhibiting necrosis or sometimes called as slough, debridement is required. Debridement is important, as it holds a couple of major roles, such as:
- Promoting new, healthy skin tissue growth which is sometimes inhibited by the formation of necrosis.
- Minimizing the possibility of infection, since dead skin tissues commonly produce unpleasant odor, bacteria will tend to come to the site. Hence, infection can easily happen. Debridement removes these dead tissues, so that infecting bacteria is also inhibited, lowering the possibility of infection.
When is debridement necessary?
Not all kinds of wounds require debridement, as this treatment might instead, worsen the wound condition and slow down the healing process. Chronic wounds require debridement more than acute wounds.
- Open wounds from surgeries, and ulcers might not be able to be evaluated properly before its dead tissues are removed.
- Wounds with abscesses also require debridement to drain the pus and other drainage with unpleasant odor.
- Wounds caused by burns. This type of wound tends to form a black crust on the outer layer of the wound, while the inner tissues remain too soft, yellow, or white, and inflamed. As the black crust may delay healing process, it needs to be debrided.
How is dead skin removed from wounds?
Removing dead skin from wounds can be done through some procedures. However, these are not procedures to be performed at home. Patients undergoing surgeries, for instance, will be told to get back to see the doctor several days after surgery for a wound debridement procedure. Dead skin or tissues are removed from wounds using one of these debridement methods:
Surgical (sharp) debridement
With surgical debridement, dead skin or tissues are removed from a wound using sharp objects in a surgical procedure. Commonly, scalpels, scissors, or other sharp instruments are used for cutting necrotic tissues or necrosis from a wound. A topical anesthetic is usually required to be applied around the wound edge to minimize caused pains. Surgical debridement is done through some steps:
- Cleaning the wound and its surrounding area with saline solution, which functions as an anti-bacterial fluid.
- Applying topical anesthetic.
- Gripping dead tissues or skin with sterilized medical forceps.
- Cutting the necrosis little by little using scalpel or scissors.
This type of wound debridement is done using the help of soaked wound dressing. The idea is that the soaked dressing which is placed onto the wound bed will be able to pick dead skin tissues from the wound. Mechanical debridement is done as follow:
- Moistening wound dressing in saline solution.
- Adhering the dressing to dead tissues and leave it overnight.
- Removing the dressing—pulling away the necrosis at the same time.
Although it is the oldest method of wound debridement, mechanical debridement is not recommended, as healthy tissues might also be pulled away during the procedure, leaving the wound re-bleed and the healing process inhibited.
Maggot debridement, despite how disgusting it may sound, is getting popular for some reasons, such as:
- Many people find it quite painless.
- It causes minimum bleeding, so that the treatment fits people with diabetes and other diseases which make surgeries dilemmatic.
- It is more effective, since maggots can differentiate dead tissues from the healthy ones.
Maggot debridement is done by placing sterilized maggots to the wound bed and close the wound within a certain period to provide moist environment. These maggots will eat away the dead skin tissues from the wound bed. However, they will leave healthy tissues alone, so that the treatment becomes effective. When dead tissues are completely removed, maggots are removed from the wound site as well, with the help of medical fluids or forceps. Despite its simplicity, maggot therapy should not be performed at home, since it requires maggots from sterilized fly eggs.