Using color to guide debridement

Chronic wounds are typically halted in the inflammatory stage of wound healing secondary to a prolonged inflammatory response of the body to bacterial colonization, as planktonic bacteria and biofilm and senescent cells present at the wound's edges. Surgical debridement of these wounds is a critical step taken by the treating physician to attain complete healing. In order for debridement to successfully reset the stages of wound healing, residual biofilm and senescent cells must be removed. Despite the importance of complete and thorough debridement, few methods exist, and even fewer articles have been written describing techniques to ensure that all portions of a wound are equally addressed with each procedure. Using methylene blue dye to color the wound allows the surgeon to address and debride all portions of the wound adequately. In addition, the surgeon must be very familiar with what the normal tissue colors are following removal of the methylene blue-dyed tissue. Getting to tissue with those colors provides an end point to the debridement and helps prevent removal of excess healthy tissue. This article describes the primary author's technique for staining tissues with methylene blue dye prior to wound debridement, as well as the colors to look for to signal completion of surgery. In addition, a review of biofilm and senescent cells is presented as both are targeted but frequently missed when wounds are incompletely debrided.