What is Autolytic Debridement of Bed Sores?

Treatment for a bed sore may require debridement if the sore has progressed enough to have caused necrosis, or tissue death. Debridement is the removal of dead tissue, to allow the wound to heal properly. Debridement is important for preventing infections – one of the most dangerous potential complications of a bed sore. Autolytic debridement is one of several ways to debride a bed sore. Others include chemical, biological, and mechanical debridement.

The Process for Autolytic Debridement

A bacterial imbalance in a bed sore can lead to failure of the wound to heal, low tissue quality, and increased risk of infection. Treating a bacterial imbalance through methods such as debridement is critical for healthy skin tissues and successful healing. Debridement removes nonviable tissue, which can get in the way of healthy tissue growth. It controls and prevents infections by getting rid of dead and decaying tissues. It also helps define the borders of the wound and stimulate healthy cell regrowth.

Autolytic debridement uses a naturally occurring physiological process to clean a wound. It involves the natural breakdown (lysis) of damaged skin tissues at a bed sore site using the body’s defense system. Certain enzymes digest specific parts of body tissues. Using special dressings and films on the wound can stimulate natural enzyme digestion of dead tissues. Autolytic debridement can break down and eliminate dead skin tissues while leaving healthy tissue intact.

To trigger natural lysis, physicians may use dressings such as hydrogels, alginates, and hydrocolloids to produce the moist environment that is an optimal condition to activate the patient’s natural enzymes and white blood cells. Sometimes, if the process does not begin naturally, a doctor can add exogenous, or external, enzymes to move the autolytic debridement along. Autolytic debridement is a safe way to clean a bed sore wound that harnesses systems already available naturally in the body.

Autolytic vs. Other Types of Debridement

Debridement can clean the wound, prevent infections, reduce odor, limit the number of dressing changes the patient needs, and encourage proper healing of a bed sore. A physician will select the appropriate type of debridement process according to the wound and patient. The correct type of intervention is key to the patient’s prognosis. With a handful of different debridement options, it may take a full wound analysis to choose the correct one:

• Chemical. Chemical debridement uses the topical application of enzymes to break down the dead skin in the bed sore, such as Collagenase, Papain, or denaturing agents.
• Mechanical. Mechanical debridement uses wet and dry dressings that alternate regularly during the healing process. It involves consistent skin trauma and can be painful.
• Surgical. Surgical, or sharp, debridement surgically removes dead tissues using a sterilized scalpel and forceps. It allows surgeons to also check for bleeding or blood clot problems.
• Biological. Biological debridement uses maggot therapy, or the administration of maggots onto the bed sore. The maggots eat the decayed tissue and leave healthy tissue intact.

It is a physician’s role to develop the correct bed sore treatment plan according to the patient and situation. A more severe or late-stage bed sore may require more aggressive debridement procedures, such as surgery, while an early-stage bed sore may not require debridement at all. A doctor can review a patient’s different debridement options, listing the pros and cons of each, before deciding upon the best course of action.

Preventing Bed Sores

Debridement is only necessary after a bed sore has gone untreated long enough to cause tissue necrosis. The best option for a patient is always to catch a bed sore early, or to prevent it from forming to begin with. Preventing bed sores takes staying mobile, even when bedridden or in a wheelchair. A caretaker should exercise a patient once every hour or two to prevent excessive pressure or friction to one area of the body. Otherwise, a bed sore can form.

Sources

• What is Autolytic Debridement of Bed Sores?
• Autolytic debridement for pressure ulcers
• Wound and Pressure Ulcer Management
• Autolytic debridement for pressure ulcers