Understand: Enzymatic Debridement

Enzymatic debridement is fully explained in this demonstration. Wound care physician Chris Leonard, DO demonstrates how to apply an enzymatic debrider. Leonard discusses the indications for using enzymatic debridement for the removal of necrotic tissue in a wound. This demonstration is performed by a trained wound care physician for educational purposes only and should not be tried at home.

This short video is about the application of an enzymatic debrider. In this case, it’s a collagenase which breaks down collagen. It is important for helping to remove enzymatically necrosis within a wound.

Here we have a wound. In this case, it may have been just post-debridement or there may have not been any debridement on it so far whatsoever. Either way, prior to application of the enzymatic debrider, you want to make sure the wound is cleaned with saline and the appropriate protocols. And, the skin around it is dry and there’s no loose debris. At that point, you want to apply the enzymatic debrider within the margins of the wound.

You want to apply the enzymatic debridement ointment to the base of the wound. Now, the base of the wound could appear to be fairly clean and have minimal necrosis. Or, there could actually be some residual black necrosis which was not able to be removed at this particular visit due to pain, bleeding or various other reasons. In which case, it’s possible to score it which increases the surface area for the collagenase to work. Either way, the application is such that you apply it within the wound trying to avoid the wound edges. You generally try to provide a uniform coating of approximately 2 millimeters thick.

After the application of the enzymatic debrider, you’d like to make sure that the base is fully covered and that there’s not any of the enzymatic debrider on the wound edge and the periwound surface of intact skin because that will contribute to maceration.

The dressing that’s put on top of this is obviously dependent on the wound. If it’s a highly secretive wound the secretions will activate the enzymes within the ointment. In which case, you really don’t need a very moist dressing. However, if it’s a dry wound a moist dressing is preferred because it will help activate the enzymes within the ointment and increase the efficacy of the treatment.

One thing also to make note of is that silver or iodine containing dressings, silver and iodine will inactivate the enzymatic action and should not be used in combination or in conjunction with enzymatic debriders.

After the dressing is applied, generally enzymatic debriders are changed once every day. If however, the wound is highly secretive you may increase the frequency so that you don’t incur maceration on the periwound surface. It’s not common to decrease the frequency much from Q-24 hours.

The reason you may use enzymatic debridement as opposed to other forms are many. One is if you have debrided a wound but there’s still some residual necrosis, either black bio-film or gray necrosis that’s residual and you’d like to without mechanically disrupting the base of the wound any further, or causing bleeding, have some continuous effect over the next week before you come back for your serial debridement in terms of removing necrotic debris.

The second reason post-debridement is that you might have some residual black necrosis, which we mentioned earlier. Which you can score, increase the surface area and allow the collagenase to soften for the next time. This should never be used in place of sharp debridement as sharp debridement has many other advantages other than simply the removal of necrosis. But, there are many cases in which this can be used as an adjunct or might be preferable in cases where debridement might be too painful initially, the necrosis is too adherent initially because it’s such a chronic wound and other situations similar to that.

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