When should a wound not be debrided?

Debridement may not be appropriate for dry, intact eschar with no clinical evidence of underlying infection, such as an unstageable pressure ulcer on the sacrum, buttock or heel. The intact eschar serves as a biological covering over the skin underneath.

There is a specific answer to this, and it surprises people, because it means leaving something in place that looks exactly like the thing debridement removes.

In general, debridement may not be appropriate for dry and intact eschars with no clinical evidence of underlying infection. One example is an unstageable pressure ulcer with an intact eschar at the sacrum, buttock, or heel.

Eschar is the hard, dry, dark layer that forms over some wounds. The reason for leaving an intact one alone is simple: in these cases, the intact eschar serves as a biological covering over the underlying skin defect. It is doing the job a dressing would otherwise be doing.

Both conditions matter, and they go together. Dry and intact. And no clinical evidence of underlying infection. If either one doesn’t hold, this is not the situation being described.

That’s why a dark, hard area on a heel may be left on purpose while another wound is debrided, and it’s worth knowing before you decide one wound is being neglected. It’s also why this isn’t a judgment to make at home. Whether there is evidence of infection underneath is the whole question, and it’s answered by examination.

Other reasons not to use a method apply to each particular type of debridement, so a wound that isn’t suitable for one approach may still be suitable for another. Deciding between them is the clinical work.

You should never try to do debridement yourself. That holds in both directions: neither removing nor deciding to leave is a home decision.

What to watch for

Debridement may not be appropriate for dry and intact eschars with no clinical evidence of underlying infection. Both parts have to hold.

An eschar that becomes wet, lifts, or develops redness, swelling, warmth, drainage or odor around it is no longer the situation described. Those are among the signs of infection to contact your provider about.

Pressure sores covered in dead skin are unstageable, because the depth can’t be judged. That’s why a wound in this state is watched, not assumed to be stable.

Neither removing an eschar nor deciding to leave one is a home decision. You should never try to debride a wound yourself.

Wound Wizard is general education and can’t assess your wound. Your own clinician is the right person to ask.

What we look at

  • Examining the eschar and whether it is dry and intact
  • Looking for evidence of infection underneath
  • Deciding whether to debride or to leave it in place
  • Reviewing it at each visit

Sources

  1. Wound Debridement — StatPearls, National Library of Medicine https://www.ncbi.nlm.nih.gov/books/NBK507882/
  2. How to care for pressure sores — MedlinePlus, U.S. National Library of Medicine https://www.medlineplus.gov/ency/patientinstructions/000740.htm
  3. Diabetes - foot ulcers — MedlinePlus, U.S. National Library of Medicine https://medlineplus.gov/ency/patientinstructions/000077.htm