From the Guidelines
You should not debride hard callus on a diabetic foot ulcer yourself, and instead, sharp debridement should be performed by healthcare professionals in preference to other methods, taking relative contraindications into account, as recommended by the International Working Group on the Diabetic Foot (IWGDF) 1. Debridement of hard callus on a diabetic foot ulcer is a critical procedure that requires professional medical management to prevent complications such as infection, deeper ulceration, and potentially even amputation. The IWGDF guidelines recommend sharp debridement as the preferred method for removing slough, necrotic tissue, and surrounding callus of a diabetic foot ulcer, with a strong strength of recommendation and low quality of evidence 1. More recent guidelines from 2023 also support the use of sharp debridement, stating that it should be considered as part of the best standard of care, and that other methods such as autolytic, biosurgical, hydrosurgical, chemical, or laser debridement should not be used over standard of care 1. It is essential to seek professional help from healthcare professionals such as podiatrists, wound care specialists, or physicians who specialize in diabetic foot care to perform debridement and provide proper wound care. In the meantime, keeping the area clean, applying prescribed dressings, avoiding pressure on the affected area, and maintaining good blood glucose control can support healing. It is crucial to schedule an appointment with a healthcare provider immediately if callus buildup is noticed around a foot ulcer, to prevent further complications and promote proper healing, as supported by the guidelines 1. Key considerations for debridement include:
- Sharp debridement is the preferred method for removing dead tissue and callus
- Debridement should be performed by healthcare professionals
- Relative contraindications such as pain or severe ischemia should be taken into account
- Best standard of care, including sharp debridement and basic wound dressings, should be used to support healing.
From the Research
Debridement of Diabetic Foot Ulcers
- Debridement is a standard of care for diabetic foot ulcers (DFUs) and is used to remove nonviable tissue, facilitate wound healing, and prevent serious outcomes such as amputations and infections 2, 3, 4, 5, 6
- The goal of debridement is to promote wound healing by removing dead tissue, bacteria, and other debris that can impede the healing process 2, 5
- There are different methods of debridement, including mechanical (sharp/surgical, wet to dry debridement, aqueous high-pressure lavage, ultrasound, and biosurgery/maggot debridement therapy) and nonmechanical (autolytic, enzymatic) methods 2, 6
Rationale Behind Debridement
- Debridement is used to remove nonviable tissue, which can help to prevent infection and promote wound healing 2, 5
- Debridement can also help to reduce the risk of amputation by promoting wound healing and preventing the spread of infection 3, 4, 5
- The choice of debridement method depends on the individual patient's needs and the characteristics of the wound 6
Debridement Techniques
- Sharp debridement is a common method of debridement that involves the use of a scalpel or other sharp instrument to remove dead tissue 6
- Autolytic debridement involves the use of dressings or other materials to promote the breakdown of dead tissue 2, 6
- Enzymatic debridement involves the use of enzymes to break down dead tissue 2, 6
- Biosurgery/maggot debridement therapy involves the use of live maggots to break down dead tissue 2, 6
Evidence for Debridement
- There is evidence to suggest that debridement is effective in promoting wound healing and reducing the risk of amputation in patients with DFUs 3, 4, 5
- However, the evidence is not always consistent, and more research is needed to fully understand the benefits and limitations of debridement in the treatment of DFUs 5