Safe debridement in the community

Sharp debridement

Conservative sharp debridement 

(CSD) is the removal of non-viable 

tissue using a scalpel or scissors, but 

without a general anaesthetic. For this 

reason, unlike surgical debridement, 

the practitioner only removes non-

viable material and halts the procedure 

before living tissue is reached. CSD 

is often used by specialist podiatrists 

when debriding non-viable tissue in 

the diabetic foot (Young, 2011).

It is imperative that clinicians who 

perform CSD have the knowledge and 

skills to do so safely and effectively. 

These include a sound knowledge 

of the anatomy of the area being 

debrided to prevent damage to local 

tendons, arteries, veins or nerves 

(Haycocks and Chadwick, 2012). 

For many clinicians, this is difficult 

to achieve with few post-registration 

courses on debridement available 

(an example is the MSc module in 

debridement available at Bradford 

University). Once competence is 

achieved, the clinician may have 

difficulty maintaining the skills if CSD 

is not regularly undertaken.

Clinicians need to have confidence 

in their ability to deal with any 

complications, such as, uncontrolled 

bleeding in the absence of surgical 

and anaesthetic support in the 

community setting (Haycocks and 

Chadwick, 2012). A subgroup of the 

North West Clinical Effectiveness 

Group developed an information 

leaflet identifying the risks and 

benefits of sharp debridement so 

that written informed consent 

can be obtained (Haycocks and 

Chadwick, 2008).

Sharp debridement is not 

recommended in the following 

situations:

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Debridement of the hand or face, 

foot (excluding heel region)

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Debridement in patients with 

unstable clotting mechanisms

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In the presence of localised 

wound infection

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In malignant wounds due to the 

propensity of the tissue to bleed

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In areas that involve or are 

near vascular structures, grafts, 

prosthesis, dialysis fistula or joints 

(Fairbairn et al, 2002).

Therefore, in the community setting, 

alternative debridement methods are 

viewed as a safer option.