Maintenance Debridement in Chronic Hard-to-Heal Wounds: Toward Dynamic Homeostasis and Precision Intervention

Debridement is widely used across various wound types, but its biological significance differs fundamentally between acute and chronic hard-to-heal wounds. In acute wounds, debridement directly triggers the initiation of regeneration; however, in chronic wounds, persistent biofilm, insufficient angiogenesis and dysregulated inflammation lead to a prolonged cycle of inflammation and proliferation, making traditional one-off debridement insufficient to change the healing trajectory. Therefore, the concept of debridement needs to evolve from an acute wound model to a sequential, biologically driven continuous management strategy. Maintenance debridement, by dynamically regulating the microenvironment, reducing pathological load and restoring a 'healable state', has emerged as the crucial bridge between inflammation control and regenerative therapies. This review systematically explains the theoretical basis and clinical value of maintenance debridement and explores the future direction of AI-assisted precision debridement management.