Debridement for venous leg ulcers

Abstract

Background Venous ulcers (also known as varicose or venous stasis ulcers) are a chronic, recurring and debilitating condition that affects up to 1% of the population. Best practice documents and expert opinion suggests that the removal of devitalised tissue from venous ulcers (debridement) by any one of six methods helps to promote healing. However, to date there has been no review of the evidence from randomised controlled trials (RCTs) to support this. Objectives To determine the effects of different debriding methods or debridement versus no debridement, on the rate of debridement and wound healing in venous leg ulcers. Search methods In February 2015 we searched: The Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. There were no restrictions with respect to language, date of publication or study setting. In addition we handsearched conference proceedings, journals not cited in MEDLINE, and the bibliographies of all retrieved publications to identify potential studies. We made contact with the pharmaceutical industry to enquire about any completed studies. Selection criteria We included RCTs, either published or unpublished, which compared two methods of debridement or compared debridement with no debridement. We presented study results in a narrative form, as meta-analysis was not possible. Data collection and analysis Independently, two review authors completed all study selection, data extraction and assessment of trial quality; resolution of disagreements was completed by a third review author. Main results We identified 10 RCTs involving 715 participants. Eight RCTs evaluated autolytic debridement and included the following agents or dressings: biocellulose wound dressing (BWD), non-adherent dressing, honey gel, hydrogel (gel formula), hydrofibre dressing, hydrocolloid dressings, dextranomer beads, Edinburgh University Solution of Lime (EUSOL) and paraffin gauze. Two RCTs evaluated 1 Debridement for venous leg ulcers (Review)

Diagnosis and management of venous leg ulcers

“…A Cochrane review found limited evidence (from small studies of short duration) that regular medical and surgical debridement of venous leg ulcers improves healing 46. It also reports that there is moderate quality evidence that sloughy ulcers with more than 50% of dead tissue debrided are more likely to heal 46…”

External validity of randomized controlled trials of interventions in venous leg ulceration: A systematic review

“…Cochrane Systematic Reviews of interventions for the treatment of active VLU have failed to identify any single treatment modality except compression therapy to improve healing . Healing rates remain low and plateau at around 50–60% of patients after 12 weeks of treatment, highlighting the need to examine our current evidence base as reported in randomized controlled studies (RCTs) to guide future research and optimize patient outcomes.…”

Honey and Medicinal Plants in the Management of Certain Surgical Bovine Clow Affections

“…[37] or Leptospermum scoparium [38] is documented. According to its in vivo studies; honey topical application is recommended in difficult surgical wounds such as burns [39]; chronic leg wounds [25]; venous leg ulcers [40] or diabetic foot lesions [41]. Carnwath et al (2014) tested in vitro the antimicrobial activity of different honey batches against 10 different bacterial species concluding that it may be effective topical treatment up to 16 concentration.…”