EWMA Document: Debridement: An updated overview and clarification of the principle role of debridement

Strohal, Robert; Dissemond, Joachim; O’Brien, Julie; Piaggesi, Alberto; Rimdeika, Rytis; Young, Trudie; Apelqvist, Jan

doi:10.12968/jowc.2013.22.sup1.s1

Cited by 163 publications

(122 citation statements)

References 113 publications

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“…[1][2][3] There are several methods of debridement and that is essential for a good preparation: surgical technique, high pressure irrigating device, chemical debridement, enzymatic preparation, autolytic hydrogels and hydrocolloids, the old larva therapy and the more recent negative pressure therapy. Ultrasonicassisted wound debridement is a less known debridement method that uses slow frequency ultrasound waves.…”

Section: Introductionmentioning

confidence: 99%

“…Ultrasonicassisted wound debridement is a less known debridement method that uses slow frequency ultrasound waves. 3,4 Scleroderma digital ulcers (DU) are typically acral ischemic lesions of the fingers and toes with a recurring chronic course. They are the results of spasms and occlusions of the arterial-capillary region of the fingers, determining ischemic and hypoxic damage presenting like a localized hyperkeratosis on the distal phalanges up to dermohypodermic-muscular necrosis and acroosteolysis.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, the removal of devitalized tissue is done by preferring the autolytic or enzymatic debridement (enzymatic preparation, autolytic hydrogels and hydrocolloids) characterized by repeated dressings and a slow healing process that takes several months. 3 Because of their slow tendency towards healing and long duration DU are frequently exposed to infective inflammatory complications that further slow healing.…”

Section: Introductionmentioning

confidence: 99%

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Ultrasonic-assisted wound debridement for scleroderma digital ulcers

et al. 2018

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Debridement is a key element of wound care. It involves the removal of devitalized tissue from the wound bed in order to allow wound healing. Microcirculatory ulcers in general and scleroderma ulcers in particular are extremely painful, very reactive and rather unwilling to accept aggressive local treatments of a mechanical type or surgical cleaning which can promote an abnormal phlogistic response with a necrotizing evolution. For the elimination of devitalized tissue is necessary to promote autolytic or enzymatic debridement with slow tendency towards healing frequently exposed to phlogistic infections furthermore slowing healing with high risk of gangrene and amputation. Ultrasonic-assisted wound debridement uses low frequency ultrasound waves showing three clinical effects: atraumatic selective tissue debridement, wound stimulatory effect and antibacterial activity. We compare healing time, infections and procedural pain of ultrasonic debridement with autolytic debridement as for Scleroderma digital Ulcers. There is evidence to show that Ultrasonicassisted wound debridement reduces the time of healing, needing for antimicrobial therapy, the procedural pain and consequently the cost to the healthcare system improving the patients' quality of life.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Ultrasonic-assisted wound debridement for scleroderma digital ulcers

et al. 2018

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“…12,17,29 Benefits of autolytic debridement include ease of use, little/no pain, and no damage to healthy tissue. 30 However, excessive use or use in a highly exudative wound may lead to maceration of the periwound skin, which may impede the wound healing process. 30 Enzymatic debridement is an active and selective method of wound debridement that uses naturally occurring proteolytic enzymes for eliminating barriers to the healing process.…”

mentioning

confidence: 99%

“…30 However, excessive use or use in a highly exudative wound may lead to maceration of the periwound skin, which may impede the wound healing process. 30 Enzymatic debridement is an active and selective method of wound debridement that uses naturally occurring proteolytic enzymes for eliminating barriers to the healing process. 31 Enzymatic debridement with clostridial collagenase ointment (CCO) (derived from Clostridium histolyticum) has been shown to be sparing to collagen in healthy tissue and newly formed granulation tissue.…”

mentioning

confidence: 99%

Pressure ulcer treatment in a long-term care setting: wound bed healing with clostridial collagenase ointment versus hydrogel dressing

Waycaster¹,

Gilligan²,

Milne³

2014

CWCMR

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Purpose: To compare clinical outcomes in patients with pressure ulcers (PUs) who were treated with enzymatic debridement using clostridial collagenase ointment (CCO) with those treated with autolytic debridement using a hydrogel dressing. Patients and methods: This prospective, randomized, blinded, single-site trial directly compared the use of CCO and hydrogel dressings for treatment of PUs in patients in a long-term care facility. Changes in wound bed scores (WBS), tissue granulation, wound surface area, and epithelialization were assessed weekly during the 6-week treatment. Effects of treatment time, treatment method, and the combination of treatment time and method on continuous outcomes were analyzed by linear regression; the effects of covariates on epithelialization were analyzed by logistic regression. Results: Overall, 27 patients completed the study; 13 patients were treated with CCO and 14 with hydrogel. Baseline demographic and clinical characteristics were similar between the treatment groups. Patients treated with CCO had a granulation rate approximately twice that of those receiving hydrogel and showed a significantly higher rate of granulation tissue formation at week 6. Treatment duration and the combination of treatment duration and method were significant predictors of granulation tissue formation. WBS improvements from baseline to week 6 were greater in patients who received CCO than in those treated with hydrogel (+4.6 units versus +2.6 units, respectively). Treatment duration and the combination of treatment duration and method were predictors of WBS improvement. Patients treated with CCO showed significant reductions in wound surface area from baseline (10.3 cm 2 ) to week 6 (2.1 cm 2 ). At week 6, epithelialization was numerically higher in patients treated with CCO than in patients treated with hydrogel. Conclusion: Long-term care facility patients with PUs who received enzymatic debridement with CCO had greater improvements in granulation tissue formation, WBS, wound surface area, and wound closure than did those treated with hydrogel.

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Debridement for venous leg ulcers

Gethin

Cowman

Kolbach³

2015

Cochrane Database of Systematic Reviews

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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)

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EWMA Document: Debridement: An updated overview and clarification of the principle role of debridement

Cited by 163 publications

References 113 publications

Ultrasonic-assisted wound debridement for scleroderma digital ulcers

Ultrasonic-assisted wound debridement for scleroderma digital ulcers

Pressure ulcer treatment in a long-term care setting: wound bed healing with clostridial collagenase ointment versus hydrogel dressing

Debridement for venous leg ulcers

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