Debridement is a part of the natural would healing process and is crucial to healing: removal of damaged and dead tissue, debris and bacteria minimises infection risk and encourages healthy granulation tissue to form, which aids healing (Strohal et al, 2013).
Cleaning the burn wound serves to minimise bacterial colonisation, remove loose skin, remove exudates and previous dressings and prepares the wound for the dressing.
- Clean gently with gauze and Normal Saline or 0.1% Aqueous Chlorhexidine.
- Gently remove loose skin and any residual non viable epidermis or debris. (4)
- If gauze is unavailable, a clean lint free cloth or flannel maybe useful.
All affected areas should be shaved to a 2cm border surrounding the wound to prevent infection. Hair harbors bacteria and can increase the infection risk.
Shaving should be completed during initial debridement and each dressing change if hair growth is noted in the wound.
Burn blisters occur primarily in superficial partial thickness burns but also may overlay deeper burns. An increased capillary permeability caused by the inflammatory response to the burn injury, causes oedema formation separating the epidermis from the underlying dermis.
Clinical evidence regarding the management of blisters is limited. Small blisters (<2cms diameter) can be left intact. The following types of blisters should be debrided:
- Thick walled blisters
- Blisters over joints or dependent areas
- Blisters >2cms diameter
- Ruptured blisters/loose skin
A practitioner experienced in burn blister management should perform the blister debridement.
Remove all non-viable tissue from the wound bed using either mechanical debridement with moist gauze or sharp dissection with scissors and forceps
Snip the blister, drain the fluid and cut away the dead or devitalised tissue carefully up to (but not including) the margin of sensate tissue
For more information on blister debridement, visit the London South East Burn Network Blister Management Guideline or the New South Wales Severe Burn Injury Service Blister Consensus statement