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Clinical Research
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Debridement: Approaches and Outcomes in Chronic Wound Management First Author: Katherine Jones Authors: Kristopher Fennie, Ph.D., MPH Background: Debridement is the removal of necrotic tissue and exudate from a wound to improve or facilitate the healing process. The primary purpose of debridement is to reduce bioburden and control/prevent infection. Although various forms of debridement are available (surgical, sharp, autolytic, enzymatic,mechanical), none has gained universal acceptance. Purpose: The purpose of this descriptive study was to identify debridement methods in routine practice; examine appropriateness of selected methods; and explore the relationship of selected methods to wound outcomes. Methods: This was a 4-site retrospective study of subjects over 50 years old, using chart reviews and a structured data abstraction protocol. Trained research assistants reviewed closed records, recording up to six months of data. Categories included sociodemographics, clinical variables, wound characteristics, treatment approaches, and outcomes. Results: Data were collected on 400 subjects: 114 pressure ulcers, 103 diabetic ulcers, and 183 venous ulcers. Subjects that healed (N=148) were significantly less likely to have received mechanical or enzymatic debridement. Subjects whose wounds deteriorated were significantly more likely to have received mechanical or enzymatic debridement, and more frequent mechanical or enzymatic debridement. More frequent debridement in general was associated with reduced likelihood of healing. Inappropriate debridement, defined as no debridement of documented slough or eschar, was also associated with nonhealing and deterioration. Black eschar was debrided in the majority of cases (>73%), but yellow slough was debrided only between 53%-60% of the time. Consistent with recommendations, autolytic debridement was infrequently used on infected wounds or those with thick purulent drainage. Conclusion: Sharp and autolytic debridement appear to be associated with better healing of chronic ulcers. Clinicians are less likely to debride slough compared to eschar. Changing debridement approaches might lead to improved healing rates. |
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