What is Mechanical Debridement of Bed Sores?

Mechanical debridement is an approved bed sore treatment that may be necessary in cases involving dead skin tissue, or necrosis. If loss of blood supply to an area of the body has killed all or most skin cells in the affected area, a doctor may prescribe debridement to remove dead tissues and encourage healing. Without debridement, a bed sore may not be able to properly heal, and could be at risk of infection. Mechanical debridement is one of several different types of debridement that may be appropriate depending on the patient’s injury.

What Does Debridement Mean?

A bed sore occurs when the skin does not receive enough blood, causing damage to the skin cells and tissues. Necrosis, or tissue death, can occur due to an untreated bed sore. Necrosis can impede the healthy healing of an open wound, with dead tissues potentially causing infections and health complications. It is critical to debride, or clear away, the dead tissues from a bed sore for proper healing. Debridement is usually one of the first steps in bed sore treatment, before bandaging.

Physicians can use many different methods to debride a bed sore. Biological debridement uses maggots to eat away at the dead flesh. Autolytic debridement involves the use of the body’s naturally occurring enzymes to break down dead tissues. Chemical debridement uses special topical ointments to trigger enzymatic tissue elimination. Surgical debridement uses a scalpel to remove dead tissues. Mechanical debridement is one of the oldest methods of wound debridement. It uses a combination of wet and dry dressings to remove dead tissue.

How Does Mechanical Debridement Work?

Mechanical debridement refers to a method of wound cleaning that physically removes the dead or decayed tissues from the wound, rather than something that breaks down or eats away at dead cells. A bed sore may require mechanical debridement if the wound has progressed enough to have damaged skin cells impeding healthy tissue growth. Mechanical debridement can involve three different techniques, depending on the case:

1. Wet to dry dressing. The traditional form of mechanical debridement. It involves packing a bed sore wound with wet dressings. Once the dressings dry, a physician pulls them from the wound to pull out dead tissues. Unfortunately, wet to dry mechanical debridement can be painful for the patient. It is also nonselective, and may pull out healthy skin along with dead skin. However, it is the most inexpensive form of mechanical debridement for a patient.
2. Whirlpool debridement. Whirlpool therapy is a type of hydrotherapy. It removes necrotic cells, debris, and foreign objects from a bed sore using water as a cleansing agent. The doctor will immerse the patient’s limb in a whirlpool bath for several minutes. The force of the moving water irrigates the wound and debrides the wound bed. This type of mechanical debridement could pose a risk of cross-contamination.
3. Pulse lavage. A more expensive type of mechanical debridement, pulse lavage uses a jet stream of water (typically along with an irrigation solution) to remove wound debris and dead tissues. The mechanical force of the water can remove tissues, while a suction component can remove wound debris. Pulsed lavage can improve healthy tissue growth without harming underlying tissues. The suction can also stimulate positive cell growth in the affected area.

Mechanical debridement is most appropriate in bed sore cases involving large areas of unhealthy or dead tissues. For cases with smaller or more delicate bed sores, a more selective method of removing dead skin cells may be best. Many doctors and patients prefer other types of debridement to mechanical because of the pain involved in this method, as well as the risk of pulling away healthy tissues. A few possible risks of mechanical debridement include wound maceration, desiccation, and bleeding.

Sources

• What is Mechanical Debridement of Bed Sores?
• Autolytic debridement for pressure ulcers
• Mechanical Debridement | Wound Debridement Techniques
• 5 Things You Need to Know About: Pulsed Lavage