Debridement

Burn wounds and chronic wounds can develop eschar and necrotic tissue, which interferes with the healing. Such wounds include:
– Burn wounds from thermal or chemical injury, when covering a larger surface can be life threatening.
– Chronic wounds can result from several diseases and injuries:
o Diabetic foot ulcers: 15%-25% diabetic patients develop a chronic wound, mostly in the lower leg or foot. As it is often accompanied with a neuropathy, such wounds are generally painless. Diabetic ulcers are major cause for foot and leg amputations.
o Pressure ulcers: mostly due to prolonged bed stay at home, in nursing homes and in hospitals. Common in the geriatric population, but also in e.g. spinal cord injury patients. Out of 1 million patients, some 65,000 die from complications.
o Venous leg ulcers: caused by abnormal vein function, usually on the sides of the lower leg. About half are chronic and persist for more than 6 weeks. Estimated prevalence up to 4% of the population over 65.
o Other types include surgical and traumatic wounds and other venous and arterial ulcers.

Removal of the eschar and necrotic tissue is called debridement, to enable the wound to heal. There are multiple ways of debridement, most of which are expensive, little effective, very unpleasant and painful.

– Enzymatic debridement: uses proteolytic enzymes to remove eschar / necrotic tissue, which is composed of denatured matrix proteins (collagen, fibrin, etc.). The current products on the market are too slow and cause irritation and pain, especially to the surrounding tissue. Otherwise, enzymatic debridement could be the treatment of choice.
– Autolytic debridement: are supportive non-therapeutic measures, generally supporting the body’s natural healing process.
– Mechanical debridement: uses water flow or scrubbing. It is cheap, but can be painful and bears the risk of wound infection.
– Surgical debridement: is highly effective and fast, but very expensive. It requires an operating theater and full team. It is also painful and requires general anesthesia.
– Maggots (fly larvae): is one of further methods for debridement. While effective, it can be painful and is generally not perceived well by patients.