The bedrock of modern wound care is simple: a clean wound heals faster. Yet, the method of achieving this cleanliness—debridement—remains a subject of intense debate and evolving practice. For decades, the gold standard for removing non-viable, necrotic tissue has been the swift, decisive action of surgical or sharp debridement. While undeniably effective in reducing bacterial load and jump-starting the healing cascade, this approach often presents as a single, traumatic event. Increasingly, evidence points to the need for more nuanced, continual debridement techniques that shift from a “one-time fix” to a sustained biochemical approach. This is not merely an incremental change, but a fundamental reassessment of how we manage complex wounds, offering improved outcomes, reduced pain, and a genuine acceleration of the healing process.

Surgical or sharp debridement, performed by a skilled clinician, can be critical in emergency situations or when large burdens of necrotic tissue impede circulation or harbour significant infection. Its power lies in its immediacy and completeness, offering  a means for rapid clearance. However, this method is inherently non-selective. The scalpel or curette, no matter how precisely handled, carries a risk of damaging surrounding healthy tissue and any newly formed granulation tissue. Furthermore, surgical or sharp debridement often require anaesthesia, or substantive pain relief at a minimum, a specialised procedure room, and is typically followed by a period where the wound bed quickly re-accumulates fibrin and slough, necessitating repeated sharp interventions, making any single debridement intervention merely a temporary fix.

The Case for Sustained, Biochemical Action

Continual debridement facilitated by enzymes such as tarumase, which can be used throughout the wound healing process, represent a paradigm shift toward precision and persistence. These gels, often based on established hydrogel delivery systems, typically contain a specific enzyme that selectively targets and breaks down the non-viable fibrin, collagen and elastin that anchors necrotic tissue and slough to the wound bed. This selectivity minimises trauma to the wound, preserving the fragile epithelial and granulation tissue that is vital for closure. By avoiding injury, the treatment significantly reduces the risk of inflammation, which is a major culprit in prolonging the inflammatory phase of healing and stalling the progression to proliferation. Essentially, the enzyme gel works as a biochemical scavenger, dissolving only what shouldn't be there, leaving the healing machinery intact.

Continual Efficacy and Patient Comfort

Unlike the single, episodic nature of sharp debridement, the application of an enzyme gel provides 24/7 debridement in between dressing changes. This continuous action not only removes initial slough, but also prevents its re-accumulation, maintaining a continuously clean and physiologically optimal wound bed. This persistent clearance is crucial because the regeneration of slough can create a biofilm substrate. By continually dissolving this substrate, enzyme gels can assist in both debridement and biofilm management.

Furthermore, patient experience is vastly improved. Enzymatic debridement with tarumase is typically painless, and the gel format allows for it to be performed easily in a community or outpatient setting without the need for local anesthesia or extensive specialised training. This shift democratises effective debridement, making it accessible and consistent. For the patient, a pain-free, non-invasive treatment applied during routine dressing changes vastly improves compliance and overall quality of life.

The Synergy of Speed and Safety

Critics of enzymatic debridement often compare the slower action of first-generation enzymes, such as collagenase (Santyl), with the immediacy of the scalpel. This is a valid, though incomplete, comparison. While a large, hard eschar may require an initial sharp or surgical 'de-bulking', the enzyme gel shines in the maintenance phase and in managing smaller, more diffuse slough that would be impractical or too risky to remove sharply. The true power of debridement, therefore, lies in synergy and the ideal modern strategy involves an integrated approach: a single, initial sharp debridement to clear the bulk, immediately followed by the initiation of a sustained enzymatic regimen throughout the wound healing phases. This combination leverages the speed of the scalpel for initial clearance and the precision and persistence of the enzyme gel for optimal, long-term wound bed preparation.

The potential economic implications are significant. While the gel itself incurs a cost, this can be offset by substantial savings from reducing the need for costly surgical procedures, hospitalisation, frequent dressing changes and visits over a prolonged period, as well as the expenses associated with managing wound complications (like infections) that stem from poor debridement. A simple, office-based treatment regimen that leads to a faster time-to-closure offers a clear return on investment.

Conclusion: Embracing the Chronic Condition

Wound care is fundamentally about managing a chronic condition all the way through to the final resolution of healing. Viewing debridement as a single, acute event ignores the dynamic, continuous nature of the non-healing wound and the sustained effort required for healing. The move toward continual, selective debridement with an enzyme gel is an acknowledgement that the wound environment requires constant optimisation, not just episodic intervention. It is a therapy that respects the biology of the tissue, minimises patient discomfort, and offers a more sustainable, effective path to wound closure. By making this transition, clinicians are not abandoning the scalpel entirely, but rather reserving it for where it is truly indispensable, while establishing the enzyme gel as the quiet, persistent hero in the daily battle against non-viable tissue. The future of wound care is continuous, precise, and gentle, and it is unfolding one enzyme-coated application at a time. The shift is clear: for most chronic wounds, the future is not sharp, but selective and sustained.

Author: David Fairlamb, Chief Development Officer

David has 30+ years working in drug and medical device industries (Smith & Nephew, Merck KgA, Renovo plc) and in private consultancy (ProTherax Ltd), specialising in supporting the development and regulatory approval of biotechnology, new chemical entities, drug re-purposing and drug/device borderline products, most notably in wound care and dermatology indications. At SolasCure, David ensures all development studies are designed to meet the expectations of regulators, potential partners and investors, so that SolasCure can demonstrate that Aurase Wound Gel is of the required quality for its intended use, is safe for use in patients and that it will be clinically effective for wound debridement and wound bed preparation.