Surgical Debridement

Surgical debridement in acute and chronic wounds plays a pivotal role. Debridement is believed to increase the rate and speed of wound healing and reduce the wound area by removing necrotic tissue and providing a better wound bed, including hyperkeratotic epidermis, necrotic dermis, foreign debris, and bacterial pathogens, which have inhibitory effects on wound healing (Cardinal et al., Wound Repair Regen. 17:306–11, 2009). Microarray analysis has shown a marked reduction in cytoplasmic localization of epidermal growth factor receptor (EGFR) in the epidermis, indicating that non-healing keratinocytes have a diminished capacity to respond to EGF. In addition to inhibition of epidermal and keratinocyte function, fibroblasts derived from non-healing wounds show slower migration (Brem et al., Mol Med. 13:30–9, 2007). This molecular information suggests that proper surgical debridement may be an effective solution to overcome this issue. Surgical debridement is considered essential for accelerating and optimizing wound healing; however, the evidence and rationale for this technique should be further discussed for each pathologic condition, such as leg and diabetic foot ulcers.