Table 2.

Methods of tissue debridement

Types of Debridement	Description
Surgical debridement	Removes necrotic tissues via sharp surgical excision, typically with cold instruments either at bedside or in the operating room. Most effective form of debridement but results in most underlying tissue damage.
Mechanical debridement	Removes debris by physical force. Most common type is wet-to-dry dressings that should also include wound irrigation with either normal saline or antibiotic irrigations. Results in moderate amount of tissue damage.
Autolytic debridement	Relies on innate proteolytic enzymes to break down and liquefy necrotic debris by placing an occlusive or semiocclusive dressing over the wound for 2 to 3 d while the enzymatic process takes place. Less effective at wound debridement, but is the gentlest method for underlying tissues. This method is not appropriate for highly exudative, infected or deep wounds.
Enzymatic debridement	Exogenous enzymes such as papain-urea cream or collagenase ointment are applied topically to digest and break down necrotic debris. This method is slightly harsher than autolytic debridement, but debrides tissues slightly faster.