Fiona Smith1, Nancy Dryburgh, Jayne Donaldson, Melloney Mitchell. 1. School of Nursing, Midwifery and Social Care, Faculty of Health, Life & Social Sciences, Edinburgh Napier University, Sighthill Campus, Edinburgh, UK, EH11 4BN.
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. AUTHORS' CONCLUSIONS: There is a lack of large, high-quality published RCTs evaluating debridement per se, or comparing different methods of debridement for surgical wounds, to guide clinical decision-making.
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. AUTHORS' CONCLUSIONS: There is a lack of large, high-quality published RCTs evaluating debridement per se, or comparing different methods of debridement for surgical wounds, to guide clinical decision-making.
Authors: Gregory S Schultz; R Gary Sibbald; Vincent Falanga; Elizabeth A Ayello; Caroline Dowsett; Keith Harding; Marco Romanelli; Michael C Stacey; Luc Teot; Wolfgang Vanscheidt Journal: Wound Repair Regen Date: 2003-03 Impact factor: 3.617
Authors: Jacob Zeitani; Fabio Bertoldo; Carlo Bassano; Alfonso Penta de Peppo; Antonio Pellegrino; Fadi M El Fakhri; Luigi Chiariello Journal: Ann Thorac Surg Date: 2004-02 Impact factor: 4.330
Authors: Anne F Klassen; Emiel L W G van Haren; Tert C van Alphen; Stefan Cano; Karen M Cross; Anne-Margreet van Dishoeck; Kenneth L Fan; Maarten Michael Hoogbergen; Dennis Orgill; Lotte Poulsen; Jens Ahm Sørensen; Lee Squitieri; Elena Tsangaris; Dalibor Vasilic; Andrea L Pusic Journal: Int Wound J Date: 2021-03-10 Impact factor: 3.315
Authors: Anne Klassen; Emiel Lwg van Haren; Karen Cross; Kenneth L Fan; Chris Gibbons; Maarten M Hoogbergen; Natasha M Longmire; Lotte Poulsen; Jens Ahm Sorensen; Lee Squitieri; Elena Tsangaris; Tert C van Alphen; Anne-Margreet van Dishoeck; Dali Vasilic; Andrea L Pusic Journal: BMJ Open Date: 2020-03-25 Impact factor: 2.692