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A critical question in the treatment of chronic wounds is whether and when debridement is needed. The three most common chronic wounds are the diabetic foot ulcer (DFU), the venous leg ulcer, and the pressure or decubitus ulcer. Surgical debridement, aimed at removing necrotic, devitalized wound bed and wound edge tissue that inhibits healing, is a longstanding standard of care for the treatment of chronic, nonhealing wounds. Debridement encourages healing by converting a chronic nonhealing wound environment into a more responsive acute healing environment. While the rationale for debridement seems logical, the evidence to support its use in enhancing healing is scarce. Currently, there is more evidence in the literature for debridement for DFUs than for venous ulcers and pressure ulcers; however, the studies on which clinicians have based their rationale for debridement in DFUs possess methodologic flaws, small sample sizes, and bias. Thus, further studies are needed to develop clinical evidence for its inclusion in treatment protocols for chronic wounds. Here, the authors review the scientific evidence for debridement of DFUs, the rationale for debridement of DFUs, and the insufficient data supporting debridement for venous ulcers and pressure ulcers.
Re: The role of surgical debridement in healing of diabetic foot ulcers
The influence of different debridement methods on the prognosis of elderly patients with diabetic foot ulcers and sepsis.
Yang Q, Cao Y, Fang Y, Li B, Zhao P, Wang W, Yin L, Xu H, Hu G. Minerva Chir. 2016 Jul 26
We evaluated the influence of different debridement methods on the prognosis of elderly patients with diabetic foot ulcers complicated with sepsis.
Retrospective study was adopted to study 65 hospitalized elderly patients with Wagner Grade--4 diabetic foot ulcer and sepsis in Vascular Disease Department of Shanghai TCM--Integrated Hospital. Thirty--two cases were included in the thorough debridement group and the other 33 were included in the minor debridement group. We compared the mortality rates on the 7th day and 14th day after debridement, and monitored changes of sepsis--related organ failure assessment (SOFA) score as well as C--reactive protein (CRP), procalcitonin (PCT) and D--Dimer (D--D) levels. Cox regression analysis and Kaplan-Meier analysis were used to analyze the mortality rates. Binary logistic regression analysis was employed to screen relevant prognostic factors to see the prognostic value of SOFA score, PCT and D--D.
Fatality rates of the thorough debridement group on the 7th day and 14th day of the debridement were higher than those in the minor debridement group and such a difference has statistical significance. The CRP, PCT, and D--D of patients within seven days after thorough debridement were obviously higher than those of patients after minor debridement.
Damage control should be provided for elderly patients with diabetic foot ulcers and sepsis when debridement is being performed. Palliative debridement methods such as small-scale incision and drainage are less likely to affect systematic inflammatory response and coagulation function, and thus can buy time for further treatment to improve clinical effect.