Following a burn, dead tissue provides a breeding ground for bacteria to grow and bacteria can lead to infection. The dead tissue will eventually fall off as part of the skin’s natural healing process. However, when burns are particularly severe, the natural healing process can take too long. Surgeons must act to reduce the risk of infection by "debriding" the wound. Debridement is the process of removing dead tissue and contaminated material from and around a wound to expose healthy tissue.
The surgeon may debride the wound in several ways: surgically, chemically, mechanically and autolytically. To decide which method to use, the surgeon will consider the wound’s depth, its extent and location, whether it lies close to other structures like bones, the risk of infection and antibiotic use, and the type of pain management that will be used during and after the procedure.
Dead tissue is cut from the wound by using scalpels, forceps, scissors and other instruments. Surgical debridement is the most effective method if the wound is large or deep. It is often the best choice if the need for debridement is urgent. The wound is cleaned with saline and then the dead tissue is cut. Surgical debridement often needs repeating. Sometimes skin grafts may need to be transplanted into the debrided site.
This method is one of the oldest, potentially the most painful, and most controversial. It is done by applying a saline moistened dressing over the wound and allowing it to dry and adhere to the dead tissue, when the dressing is removed the dead tissue will be pulled with it. Ouch! It is controversial because it may not remove reliably all of the dead tissue.
This is done by using enzymes and other compounds to dissolve dead tissue in the wound.
This method involves using dressings that retain wound fluids, allowing the body itself to naturally get rid of the dead tissue. It is not used if the wound is infected or quick treatment is needed, since it takes more time than the other methods and is a good method if the body cannot tolerate more aggressive treatment.
Debridement may be done under general or local anesthesia; pain medications may be administered afterwards. The debrided burned area of the wound must be properly dressed and kept clean and dry. The patient and family members must be attentive to signs of infection: discharge from the wound, color change, swelling, redness, increasing pain, excessive bleeding, fever and chills. Infections will often lengthen the hospital stay and if not treated properly may lead to pneumonia and even death.
In personal injury cases, the testimony of the health care providers who manage the burn care and debridement is helpful in explaining to the jury the nature of the care and the risks involved.