Best Practices in Debridement: Techniques, Tools, and Teamwork Across Care Settings

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Effective wound debridement requires more than just sharp tools—it demands precision, preparation, and peri-wound awareness. In this practical how-to session, vascular surgeon Dr John Lantis and wound care expert Dot Weir walk you through essential techniques, tools, and strategies for sharp debridement across care settings. Whether you're in the operating room, at the bedside, or chairside, this demonstration offers actionable insights to elevate your surgical wound care. This demonstration video was captured at the Symposium on Advanced Wound Care (SAWC) Spring 2025 in Grapevine, Texas.

Transcript:

Dr John Lantis:
Hello, welcome. We are going to talk a little bit about debridement today and, hopefully, give you some tips and tricks to use at the bedside, chairside, or perhaps even in the operating room. I’m Dr John Lantis, a vascular surgeon in New York City, and I’ve been involved in wound care for a long time. I’m joined today by my very good friend, Dot Weir.

Dot Weir, RN, CWON, CWS:
Hello, I’m Dot Weir. I am a long-time wound care nurse—now in my fifth decade of practice, which I can hardly believe. I currently work part-time at the Holland Hospital Wound and Ostomy Clinic in Holland, Michigan.

Dr Lantis:
I think many of us, Dot, when we think about debridement, we think about sharp debridement or episodic debridement. The patient comes to clinic or you're on the floor, and you need to decide—can I do something sharp, or what are my other options? But we often overlook the peri-wound. It's not just about the wound itself—we have to address the surrounding tissue too.

Ms Weir:
Exactly. I'm usually the one prepping the patient rather than performing the debridement. And there's so much that goes into that. Where is the patient? Are they in long-term care, an outpatient wound care center, or an inpatient setting? Regardless, proper skin preparation is essential. One of my biggest passions is wound cleansing. If a patient is undergoing debridement—or even just a dressing change—we need to cleanse with an antiseptic cleanser. We’re often causing bleeding and exposing deeper tissue, so the area must be as clean as possible. Cleanse the wound and the peri-wound—at least 4 to 6 centimeters beyond the wound edge—to prevent cross-contamination. And cleansing is also critical after debridement, but I’ll hold that thought for later.

Dr Lantis:
Great point. Dr Paul Kim and I have published on bacterial burden reduction when comparing operating room vs clinic-based debridement. A big difference is observed, and part of that is due to pre-op antimicrobial prepping. Dot, with that in mind, what would you recommend for peri-wound cleansing and wound prepping in bedside or clinic settings prior to excisional debridement?

Ms Weir:
It depends on what's available, but recent literature has evaluated therapeutic index and efficacy of various cleansers. One thing I can say definitively—normal saline is not ideal. We joke that many clinicians just "anoint" the wound with a splash of saline and call it clean. If you're performing debridement—especially sharp—you should use an antimicrobial cleanser with low cytotoxicity. You want to reduce the bacterial load without harming viable cells. In the OR, povidone-iodine or CHG is commonly used for larger prep areas, but we often skip that step in bedside debridement. Having the right cleansers available beforehand is critical.

Dr Lantis:
Also key is having a proper setup. Even for mechanical debridement, you can't just reach into your pocket and go. Dot, given your experience establishing clinics across the country, what would you consider a minimum setup?

Ms Weir:
It's not acceptable to pull tools out of your bag and place them directly on the bed. Aseptic technique is essential. Use a table—wipe it down first. Lay a barrier, like the packaging from your sterile instrument tray. That package can serve as your sterile field. Open it partially to allow the clinician access to instruments while keeping them sterile.

Dr Lantis:
Exactly. For this demo, we’re working with a previously frozen porcine foot—safe for this environment, no gloves needed here. But in real settings, we’d wear gloves and prep the area with an antimicrobial like povidone-iodine.

Ms Weir:
Also, don’t forget patient preparation. Beyond obtaining informed consent, you must explain the procedure, address potential discomfort, and ensure proper positioning. The wound must be accessible, and the patient must remain still during sharp debridement.

Dr Lantis:
Yes, we were just discussing that recently. Pain control is vital. Options include topical lidocaine gel, or even long-acting agents like EMLA. Depending on the wound and location, you might use injected lidocaine—with or without epinephrine. And again, whether formal consent is needed may depend on facility policy.

Let’s review tools. This curette has a triangular shape. The apex is sharp—excellent for excisional work. The base is dull, useful for working around wound edges. Hospital-supplied curettes are often dull and inadequate. Smooth forceps can help lift slough or coagulum from the wound base, while toothed forceps are better for edges.

Ms Weir:
As the assistant, I would open and present the instruments while maintaining sterility—only handling the instrument by the handle.

Dr Lantis:
There are three main types of scalpels: the #15 blade (small, curved), the #10 blade (larger—good for callus or eschar), and the #11 blade (sharp, pointed—good for incising abscesses, but rarely used in debridement). Cross-hatching for enzymatic debridement (eg, collagenase) is best done with a #10 or #15 blade.

Ms Weir:
Right. The cross-hatching helps topical enzymes penetrate hard, dry eschar—like doing tic-tac-toe on the wound surface.

Dr Lantis:
Scissors, curettes, and forceps often come in trays. Curved scissors (like iris scissors) are preferred over suture removal scissors. And remember—not to be a “one-handed surgeon.” Use one hand to stabilize tissue while debriding with the other.

Use forceps or even the back of the forceps as a blunt debrider if needed. Debridement should continue until you reach healthy punctate bleeding—signaling viable tissue.

Ms Weir:
At the end, we need to cleanse again. Debris from the procedure must be removed before applying a dressing. Apply pressure for hemostasis, and if needed, use hemostatic agents like Surgicel or Gelfoam. Collagen-based products work but are slower. Always be prepared with these materials.

Dr Lantis:
Post-procedure irrigation is also key. Would you use saline or an antimicrobial?

Ms Weir:
At that point, an antimicrobial with a high therapeutic index is ideal. Saline is acceptable, but I prefer antiseptics that are effective yet gentle on healthy tissue. Avoid cytotoxic agents like full-strength povidone-iodine on fresh tissue.

Dr Lantis:
To summarize:

• Cleanse the wound and peri-wound thoroughly.
• Prepare appropriately based on the debridement method.
• Use sterile technique and correct tools.
• Ensure patient comfort and positioning.
• Achieve hemostasis.
• Irrigate again and dress the wound.

Thank you for joining us. We hope this discussion provided practical insights for your wound care practice.

Ms Weir:
At the chairside!

Dr Lantis:
Thank you!