Toward a practical framework for debridement in chronic wounds: findings from a United States-based multidisciplinary...

Effective debridement is a cornerstone of wound bed preparation and healing. Despite widespread recognition of its importance, practical guidance for selecting and sequencing debridement methods across diverse care settings remains limited.

To provide United States-based, patient-centered recommendations incorporating debridement into the continuum of wound management.

A 9-member panel composed of experts in vascular surgery, podiatric surgery, plastic and reconstructive surgery, general surgery, nursing, physical therapy, and basic science convened in Grapevine, Texas, in April 2025. Using nominal focus group methodology, these experts developed 20 draft statements from discussion transcripts and refined them through 2 survey rounds using a 5-point Likert scale. Interpanelist agreement was assessed using Kendall's W and Spearman rank correlation coefficient analysis.

Seventeen consensus statements were finalized, reflecting high agreement (Kendall's W = 0.566). Core themes included matching debridement to wound goals and patient factors, adopting a dynamic escalation/de-escalation ("chutes and ladders") approach, and emphasizing communication, pain control, and diagnostic adjuncts. The panel stressed flexibility, clinician judgment, and patient-centered care when integrating debridement strategies across settings.

This United States-based multidisciplinary consensus provides practical, patient-centered guidance for selecting and sequencing debridement methods across wound types and care settings, supporting clinicians to apply flexible, evidence-informed strategies to optimize wound bed preparation and healing outcomes.