Debridement for surgical wounds

Abstract

Background Surgical wounds that become infected are often debrided because clinicians believe that removal of this necrotic or infected tissue will expedite wound healing. There are numerous methods available but no consensus on which one is most effective for surgical wounds. Objectives To determine the effect of different methods of debridement on the rate of debridement and healing of surgical wounds. Search methods In March 2013, for this third update, we searched the Cochrane Wounds Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. Selection criteria We included randomised controlled trials (RCTs) with outcomes including at least one of the following: time to complete debridement or time to complete healing. Data collection and analysis Two review authors independently reviewed the abstracts and titles obtained from the search, extracted data independently using a standardised extraction sheet and independently assessed methodological quality. One review author was involved in all stages of the data collection and extraction process, thus ensuring continuity. Main results Five RCTs (159 participants) were eligible for inclusion; all compared treatments for infected surgical wounds and reported time required to achieve a clean wound bed (complete debridement). One trial compared an enzymatic agent (streptokinase/streptodornase) with saline-soaked dressings. Four trials compared the effectiveness of dextranomer beads or paste with other products (different comparator in each trial) to achieve complete debridement. Meta-analysis was not possible due to the unique comparisons within each trial. One trial reported that dextranomer achieved a clean wound bed significantly more quickly than Eusol, and one trial comparing enzymatic debridement with saline-soaked dressings reported that the enzyme-treated wounds were cleaned more quickly. However, methodological quality was poor in these two trials.

Biofilm-based Healthcare-associated Infections

“…Mechanical: Mechanical debridement encompasses a variety implements from the use of wound dressings to the surgical removal of dead tissue. Despite this array of debridement methods, there are no clinical trials to support which of these methods are the most effective in the debridement of wounds (Dryburgh et al 2008;Levine et al 2013). …”

Evidence-based decisions for local and systemic wound care

“…Aloe vera may delay wound healing compared with gauze Wasiak and Cleland 23 2010 TNP for partial-thickness burns 5b A reduction in burn size at day 5 was seen when TNP was compared with SSD Dryburgh et al 24 2011 Debridement for surgical wounds 5c Insufficient evidence for the effectiveness of debridement alone or the choice of different methods to achieve a clean wound bed 5b…”

The Physiology of Wound Healing by the Medicinal Maggot, Lucilia sericata

“…Other existing methods of debridement include sharp (conservative, surgical and laser), chemical, enzymic and mechanical (wet-todry dressings, pressurised irrigation and vacuum-assisted closure) debridement (Dryburgh et al, 2008;Schultz et al, 2003). Other existing methods of debridement include sharp (conservative, surgical and laser), chemical, enzymic and mechanical (wet-todry dressings, pressurised irrigation and vacuum-assisted closure) debridement (Dryburgh et al, 2008;Schultz et al, 2003).…”