The debridement of chronic wounds: a systematic review.

Abstract

Health Technology Assessment is indexed in Index Medicus/MEDLINE and Excerpta Medica/ EMBASE. Copies of the Executive Summaries are available from the NCCHTA web site (see overleaf). NHS R&D HTA Programme T he overall aim of the NHS R&D Health Technology Assessment (HTA) programme is to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and work in the NHS. Research is undertaken in those areas where the evidence will lead to the greatest benefits to patients, either through improved patient outcomes or the most efficient use of NHS resources. The Standing Group on Health Technology advises on national priorities for health technology assessment. Six advisory panels assist the Standing Group in identifying and prioritising projects. These priorities are then considered by the HTA Commissioning Board supported by the National Coordinating Centre for HTA (NCCHTA). This report is one of a series covering acute care, diagnostics and imaging, methodology, pharmaceuticals, population screening, and primary and community care. It was identified as a priority by the Pharmaceutical Panel and funded as project number 93/29/01. The views expressed in this publication are those of the authors and not necessarily those of the Standing Group, the Commissioning Board, the Panel members or the Department of Health. The editors wish to emphasise that funding and publication of this research by the NHS should not be taken as implicit support for the recommendations for policy contained herein. In particular, policy options in the area of screening will be considered by the National Screening Committee. This Committee, chaired by the Chief Medical Officer, will take into account the views expressed here, further available evidence and other relevant considerations. Reviews in Health Technology Assessment are termed 'systematic' when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others.

Management of venous leg ulcers: Clinical practice guidelines of the Society for Vascular Surgery® and the American Venous Forum

“…223,224 However, the frequency and method of débridement are not well studied and have not been well established as related to the incidence of wound closure. 225 The efficacy of topical anesthesia for débridement of venous leg ulcers was recently reviewed by the Cochrane Database. 226 They identified six trials evaluating eutectic mixture of local anesthetics (EMLA) lidocaine-prilocaine cream compared with control.…”

The prevention and management of pressure ulcers

“…Although widely recommended, it remains unclear whether wound debridement is a beneficial process that results in a greater frequency of complete wound-healing. 81 There are no studies that compared debridement with no debridement in wound healing. The use of debridement can result in a shorter time to a clean wound bed in anticipation of surgical therapy.…”

“…82 A total of five trials have not shown that enzymatic agents increased the rate of complete healing in chronic wounds compared to control treatment. 81 One trial showed an increase in wound size with both collagenase and the control treatment, but the increase was significantly less in the enzyme-treated group. Only one trial out of four that compared a hydrogel with a control treatment found a statistically significant difference between treatments.…”

Reducing the incidence of foot ulceration and amputation in diabetes

“…Various means of débridement are available. Sharp débridement has been the most well studied [52], but a literature review concluded that there is limited evidence on the efficacy of this method [53]. Other agents for débridement include enzymes, hydrogels, hydrocolloids, and larval therapy.…”

“…Other agents for débridement include enzymes, hydrogels, hydrocolloids, and larval therapy. There is insufficient evidence that supports one of these methods of débridement over another, but further studies are needed [53]. Following débridement, reduction of edema has been shown to be effective in healing foot ulcers.…”