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T - Tissue

The products used in the T.I.M.E. clinical decision support tool may vary in different markets.  Not all products referred to may be approved for use or available in all markets.  Please consult your local Smith & Nephew representative for further details on products available in your market. 


Develop and promote viable, healthy wound bed tissue

Devitalized or non-viable tissue has no blood supply and will not repair with time or treatment. Presence of this tissue will delay healing and prevent granulation1. To help optimize treatment efficacy, non-viable tissue must first be removed to allow the wound to heal1-4.

Choosing the correct debridement method

Debridement choice should take into consideration the patient’s circumstances and wellbeing, practitioner expertise and available resources.




Surgical or sharp

Best for: visible necrotic tissue.
Not recommended for: low pain tolerance, insufficient blood flow or patients on anticoagulants.

Quickly removes visible, macroscopic wound debris using a scalpel, curette, rongeur or other instrument. Often used on a large area it can be painful and costly, if an operating room is required5,6.



Best for: Necrotic tissue on less compromised patients, or for patients who cannot tolerate other methods.
Not recommended for: Patients with a low pain tolerance or compromised immune system.

Forcibly removes necrotic tissue through physical force, such as frequent dressing changes. It can sometimes be performed by the patient, but can be painful and sometimes removes healthy tissue5,6.



Best for: Chronic or burn wounds that are not progressing, and patients with a low pain tolerance.
Not recommended for: Wounds that are progressing, early stage ulcers or for patients allergic to collagenase.

Digestion of necrotic tissue through a topical collagenase enzyme. Slow but specific, requiring regular dressing changes, it can prove faster than autolytic debridement and can be used in conjunction with other debridement strategies (5-7).


Best for: Some patients with a strong immune system, early stage ulcers or wounds that are healing.
Not recommended for: Stalled wounds or immunocompromised patients.

Passive support for the body’s natural debridement processes, such as enzymes and moisture. It can be less painful and can specifically target necrotic tissue. Examples include:
- Occlusive or semi-occlusive dressings
- Hydrocolloids or hydrogels
- Hypertonic saline, medicinal honey or dressings that promote autolytic debridement by osmosis.
- Some antiseptics, such as silver, medicinal honey and iodine-based products5,6.



Best for: Highly selective debridement and preservation of healthy tissue.
Not recommended for:
Patients with an aversion to maggots or fast removal of bulk debris.

Biosurgical debridement, or maggot therapy, uses sterile larvae to selectively digest necrotic tissue. While quick and effective, it is not readily accepted by all professionals and patients5,6


VERSAJET  II Hydrosurgery

Best for: Visible necrotic tissue.
Not recommended for: Patients who use anticoagulants or have insufficient blood flow. Particular care is required for patients with blood clotting disorders such as hemophilia.

A powerful saline waterjet removes necrotic tissue more selectively than mechanical debridement. As an alternative to surgical debridement, it can require an operating room, instruments and training. Potentially available in an outpatient setting, depending on patient circumstances5,6,8,9.


Hydrosurgery – Speed precision and accuracy of VERSAJET debridement on chronic wounds >


Assess the wound to identify the right treatment or intervention

Using our T.I.M.E. decision support tool. Coming soon: register here for notifications >


Necrotic/eschar: treat with enzymatic debriding agent or hydrosurgical debridement

Collagenase SANTYL Ointment**
VERSAJET II Hydrosurgery System



Slough: treat with an enzymatic debridement agent*

Collagenase SANTYL Ointment**


  Next step > Evaluate the effectiveness of treatment and progression towards your wound management goal.


For additional product information or ordering instructions, arrange a call from a Smith & Nephew representative.


Helping you get CLOSER TO ZERO human and economic cost of wounds. 

A healthcare professional must always rely on his or her own professional clinical judgment when deciding whether to use a particular product when treating a particular patient. Smith & Nephew does not dispense medical advice and recommends that healthcare professionals be trained in the use of any particular product before using it on patients.


For detailed product information, including indications for use, contraindications, effects, precautions, warnings, and important safety information, please consult the Instructions for Use (IFU) prior to use.


*Use appropriate secondary dressings according to your local protocol.
** Collagenase SANTYL Ointment 250 units/gram is indicated for debriding chronic dermal ulcers and severely burned areas.

Occasional slight transient erythema has been noted in surrounding tissue when applied outside the wound. One case of systemic hypersensitivity has been reported after 1 year of treatment with collagenase and cortisone. Use of Collagenase SANTYL Ointment should be terminated when debridement is complete and granulation tissue is well established. See complete prescribing information for more details.



1) Atkin L. 2014, ‘Understanding methods of wound debridement’, British Journal of Nursing, 23, pp. S10-5.
2) Wilcox JR, Carter MJ, Covington S. (2013) Frequency of debridements and time to heal: a retrospective cohort study of 312, 744 wounds. JAMA Dermatol 149(9).
3) Grothier L. 2015, ‘Improving clinical outcomes and patient experience through the use of desloughing’, British Journal Of Community Nursing, 20, Sup9, pp. S25-31.
4) European Wound Management Association (EWMA). Position Document: Wound Bed Preparation in Practice. London: MEP Ltd, 2004.
5) Enoch S, Harding K. Wound bed preparation: the science behind the removal of barriers to healing. Wounds. 2003;15:213-229.
6) Vowden K, Vowden P. Debridement made easy. Wounds UK [serial online]. 2011;7:1-4.
7) Ramundo J, Gray M. Enzymatic Wound Debridement. Journal of Wound, Ostomy and Continence Nursing. May/June 2008, Volume :35 Number 3:273 – 280.
8) Granick MS, et al. “Efficacy and cost-effectiveness of a high-powered parallel waterjet for wound debridement”, Wound Repair And Regeneration, 2006, 14, 394-397.
9) Madhok BM, Vowden K, Vowden P.(2013), New techniques for wound debridement. Int Wound J, 10: 247–251.