Dry Necrosis, Wet Necrosis: When to Debride, When Not to Debride

Skin necrosis is a result of several local and systemic factors, which have to be explored before indicating local debridement, among them being the local vascularisation. Multiple debridement technologies are nowadays available and should be adapted to the local availabilities and expertise. Most of the caregivers do not feel comfortable to debride deeper than 2 cm from the wound edges; experts are more familiar with the local anatomy and are more prone to excise all undesired tissues or to deroof a necrotic cap when necrosis is the small visible symptom of a large underlying cavity. A skin necrosis may hide a noble structure like tendon or bone, or even a vessel. Bone biopsy, needed to assess a bone infection, should be taught and trained, as well as the proper handling of negative-pressure wound therapy (NPWT) instillation with specific debriding foams. In case of non-revascularisable ischaemia, experts could use antibacterial creams (Flammacerium), which block the capacity of germs to penetrate on the edges of the necrotic crust inside the elimination folds.