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The goal of treatment is to create a healing environment. This may require debridement (removing necrotic tissue) so new cells can form. Various types of debridement are available. These are performed by physicians and certified specialists. To control pain, consider analgesia when appropriate.
Sharp debridement removes dead tissue with a scalpel, scissors, or other sharp instrument. Extensive removal may require surgery. Sharp debridement allows for precise removal of tissue and is the preferred method for patients with active infections. Keep in mind this technique can be painful.
Enzymatic debridement uses topical agents containing enzymes to dissolve dead tissue. They attack the fibrin and collagen of necrotic tissue and exudate. If eschar is present, tiny cuts may need to be made before applying the enzymes to help ensure their absorption. This “cross-hatching” is done by a physician or specialist.
Autolytic debridement uses the body’s own enzymes to break down necrotic tissue. Special dressings are used to keep the wound moist, allowing the necrotic skin to slowly separate from healthy tissue. Autolytic debridement can take up to several weeks, but is less painful than other methods. It’s also selective in the tissue it removes. Autolytic debridement should not be used on patients with active infections.
Mechanical (wet-to-dry) debridement may be used to remove debris and dead tissue. It involves applying a piece of gauze moistened with saline to the wound and letting it dry. The dried gauze is then removed, taking tissue and debris with it. This is not a favored method because it is nonselective, meaning it may remove healthy tissue as well as dead tissue. Wet-to-dry debridement can also be quite painful for patients.