ABSTRACT
INTRODUCTION Debridement should ideally be realized in an operative room where electrocoagulation, sterile drapes, and adequate anesthetic drugs are available. This surgical ambiance is needed especially when a surgical exploration has to be completed. In most of the cases, this step-by-step approach is the guarantee of a complete resection of necrosed areas, sloughy tissues, and undermined cavities hidden to a superficial evaluation. Debridement must be understood as a progressive evaluation of the lesions under the visual control of the professional, a person able to decide which tissue should be kept and which one should be removed. Debridement is adapted to the pathology, and the need for a complete removal of necrotic tissue is different in an extensive infection of the soft tissues like in Fournier gangrene than on a venous leg ulcer. Aggressive surgical debridement is considered as a means to accelerate closure of diabetic foot ulcers (DFU). In 1996, Smiths et al. (1) advised surgeons to debride the edges of the infected diabetic ulcers with large margins. Steed et al. (2) demonstrated in 1997 that surgical debridement of surrounding callus, necrotic tissues, and undermined ulcers’ edges was associated with greater incidence of healing, even if this issue was considered as a secondary end point in this study designed primarily to analyze results of application of a skin substitute. Debridement is considered by most trauma surgeons as a standard of care. In chronic wounds, the presence of necrotic tissues is considered as one of the main reasons for wound-healing delay (Fig. 1). The appropriate extent of debridement is still a debate, especially as complementary techniques like powerful hydrojets and negative pressure therapy have been developed. The appropriate tool used to debride is a topic of debate, and the cutting, removing, destructing, washing, and aspirating properties of a technique/device have been compared and analyzed in order to choose the best indication in a defined condition (3).
