Maintenance debridement in the treatment of difficult-to-heal chronic wounds. Recommendations of an expert panel

Abstract

Introduction: Maintenance debridement has been proposed as a therapeutic intervention to address the problem of chronic wounds characterized by an adequate wound bed but absent or slow healing. A panel of experts convened to address the rationale and method of maintenance debridement.

Purpose: The goals of the panel were to summarize the scientific rationale for maintenance debridement, discuss the biochemical and cellular abnormalities in the wound bed, and provide a working algorithm for how maintenance debridement should be used.

Methods: A multidisciplinary panel of wound healing and wound care experts comprising the fields of nursing, dermatology, internal medicine, and surgery was assembled to address maintenance debridement from different points of view and offer a unified approach.

Findings: The chronic wound contains a number of microbial, biochemical, and cellular features and abnormalities that prevent or slow its progression to healing despite a seemingly adequate wound bed. Under these circumstances, maintenance debridement is proposed as a way to remove tissues that are colonized with an excessive bacterial burden and diminish what can be described as a biochemical and cellular burden that impairs healing. A working clinical algorithm is proposed.

Conclusion: Maintenance debridement is a proactive way to "jump-start" the wound and keep it in a healing mode, even when traditional debridement may not appear necessary because of a seemingly "healthy" wound bed.