Mechanical, autolytic, or enzymatic debridement or a combination of these may be used when the need for drainage or removal of dead tissue is not urgent. They can also be used for patients who cannot tolerate surgical debridement. For surgical debridement, a scalpel, scissors, or other sharp instrument is used to remove necrotic tissue and thick adherent eschar. Although it is the quickest and most effective method for such removal, surgical debridement increases the risk of hemorrhage, infection, and wound enlargement and usually is more painful than mechanical debridement. Analgesics should be provided as needed and as appropriate.
Mechanical debridement is minimally effective on eschar.
Normal saline solution is used to irrigate the wound, cleansing it of purulent drainage or necrotic debris. The latter device provides a pulsating stream that both aids debridement and stimulates circulation. The wound should not be packed too tightly, because this inhibits the absorptive capability of the dressing and applies pressure on the area. An appropriately sized outer dressing is then applied over the packed wound to prevent contamination. This dry sterile dressing may be secured with hypoallergenic tape, Montgomery straps, stockinette, or other materials.