Jwc ewma final indd

J O U R N A L  O F WO U N D  C A R E   Vo l   2 2 .  N o   1 .  E W M A   D o c u M E N t   2 0 1 3

d

 Hydrofibers, including carboxymethylcellulose 

fibres, which turn into a gel when they come 

into contact with wound fluid, thereby aiding 

the removal of nonviable tissue. Hydrofiber 

dressings are highly absorbent and those with 

silver content and other antimicrobials are 

available on the market.

37

e

 Multi-component dressings. Some dressings 

combine autolytic, absorptive and antimicrobial 

features in the debridement process. These 

include enzyme alginogels, comprising hydrated 

alginate polymers in a polyethylene glycol (PEG)/

water matrix, embedded with an antimicrobial 

oxidase/peroxidase enzymatic complex.

38

Indications

Autolytic dressings are indicated for different kinds 

of acute and chronic wounds with necrotic tissue 

or fibrin coatings, to rehydrate, soften and liquefy 

hard eschar and slough.

33

 For example, hydrogels 

should only be used in wounds with moderate 

or no exudate, while absorptive dressings with 

autolytic properties, Hydrofibers and combination 

dressings can be used for the treatment of 

exudative (low, medium or high) wounds with 

yellow sloughy surfaces.

39

 Different products are 

available for varying levels of exudate.

Autolytic debridement can be used for  

infected wounds, only if the infection is under 

control/treatment.

Action

Autolytic debridement products have a dual 

mode of activity in wound therapies. They can 

donate water to dry wounds, or absorb fluids 

from moderately exudating wounds. The idea 

behind an autolytic debridement is a selective 

debridement by release of the patients’ endogenous 

proteolytic enzymes, such as collagenase, elastase, 

myeloperoxidase, acid hydroxylase or lysozymes, 

and the activation of phagocytes. These enzymes 

will soften, break down and dissolve necrotic 

or sloughy tissue in wounds, enabling it to be 

digested by macrophages. Most of these enzymes 

are produced by leucocytes. Another aspect of 

autolytic debridement is mediated by the high 

water content in, for example, hydrogels and the 

moisturising effect of absorptive dressings, which 

leads to swelling of necrotic tissue and fibrin 

coatings, facilitating their de-attachment. 

For an autolytic debridement, wound conditions 

must be created that are optimised for leucocytes 

and macrophages activity. This is achieved by 

creating a moist wound milieu using, for example, 

hydrogels or polymers/sugars, which absorb and 

physically bind the dissolved material, to maintain 

a moist environment in the wound.

c

  Highly-absorptive dressings absorb and bind 

wound exudate, which could delay wound 

healing, and are often combined with moisturisers, 

which keep dressings from adhering to the wound 

‘

Autolyticdebridement

isaselectivedebridement

byreleaseofthepatients’

endogenousproteolytic

enzymes,andthe

activationofphagocytes.

’

---