Debridement of a skin ulcer

It is common practice to remove (debride) any dead or poorly healing tissue from a skin ulcer surface. Although debridement has long been considered necessary to aid healing, it may not be useful for all types of venous skin ulcers.

Debridement methods include:¹

• Autolytic debridement, allowing the damaged or dead tissue to degenerate on its own by keeping the wound covered and moist, with or without special dressings. This includes:
  • The traditional gauze and zinc oxide compression bandage (called an Unna boot), wrapped around the lower leg, which hardens as it dries and can be left on for up to 10 days.
  • Occlusive dressings, including gels (IntraSite, Nu-Gel), foams (Allevyn, Lyofoam), hydrocolloids (DuoDerm, Restore), or films (OpSite, Tegaderm), under a compression bandage.
  The Unna boot promotes healing just as well as a compression bandage with a more specialized and expensive occlusive dressing underneath. But some people prefer the second method because caring for the ulcer is easier than with an Unna boot.
• Chemical debridement, breaking down dead tissue with an enzyme debriding agent (such as Santyl, Panafil, Accuzyme, or Granulex). Chemical debridement is not proven by research to promote healing any better than standard compression treatment. Some experts question whether it is of any benefit.¹
• Mechanical debridement, using a whirlpool or a stream of water (irrigation) to wash away dead tissue. Unfortunately, this method can also remove healthy, newly growing tissue.
• Surgical debridement, using a scalpel or scissors to remove dead tissue.