From the Guidelines
Iodine-based solutions are not recommended for treating necrotic tissue, and instead, debridement is the preferred method to promote healing. The use of iodine in wound care has been reevaluated in recent guidelines, and studies have shown that it may not be beneficial in treating necrotic tissue [ 1 ]. In fact, the 2024 American Heart Association and American Red Cross guidelines for first aid suggest that wound cleansing with povidone-iodine does not demonstrate a significant benefit in addition to irrigation [ 1 ].
Debridement Methods
Debridement involves the removal of dead and devitalized tissue, slough, or foreign material from the wound, and it is designed to promote wound healing [ 1 ]. There are several types of debridement, including:
- Physical debridement (e.g., surgical, sharp, hydro-debridement, or gaseous debridement)
- Biological debridement (larvae)
- Autolytic debridement (hydrogels)
- Biochemical debridement (enzymes)
Preferred Wound Cleansing Solution
For wound cleansing, normal saline is preferred over iodine-based solutions, as iodine can be cytotoxic to healthy cells and may delay healing when applied to necrotic areas [ 1 ].
Management of Necrotic Tissue
When managing wounds with necrotic tissue, it is essential to consult a healthcare provider who can assess the wound and recommend appropriate treatment, which may include enzymatic debridement agents (like collagenase), autolytic debridement with hydrogels, or surgical debridement depending on the extent of necrosis [ 1 ]. Iodine solutions are better suited for preventing infection in acute wounds or preparing intact skin before procedures rather than treating established necrotic tissue [ 1 ].
Key Considerations
The cytotoxic properties of iodine that make it effective against microorganisms can also damage new tissue formation and interfere with the body's natural healing processes in necrotic wounds [ 1 ]. Therefore, it is crucial to prioritize debridement and wound care methods that promote healing and minimize the risk of further tissue damage.
From the Research
Debridement Methods
The role of iodine in treating necrotic tissue is not explicitly mentioned in the provided studies. However, the studies discuss various methods of debridement, which is the process of removing dead tissue from the wound bed.
- Debridement methods include mechanical, autolytic, chemical, enzymatic, biological, and new debridement techniques 2
- Autolytic debridement is essential to promote wound healing and depends on keeping the whole area moist so that natural enzymatic reactions can take place 3
- Hydrogels are recognized as a standard treatment for necrotic or sloughy wounds and can promote rehydration of non-viable tissues 3
Wound Healing
Dead tissue, in the form of slough and necrosis, can delay healing and promote infection.
- Debridement describes any method by which such materials are removed, and as a consequence, the potential to achieve wound healing is enhanced 4
- The aim of debridement is to transform a chronic wound into an acute wound and to initiate the process of healing 2
- Debridement significantly reduces bacterial burden 2
Surgical Treatment
A skin-sparing approach for the treatment of necrotizing soft-tissue infections removes necrotic tissue planes while leaving viable overlying skin.
- This approach may decrease the need for graft-based reconstruction, which is associated with contracture, pain, and deformity 5
- The skin-sparing approach results in significantly more wounds closed completely by delayed primary suture of existing skin flaps and a significantly lower overall wound percentage closed by skin graft 5