Enzymatic Debridement of Chronic Nonischemic Diabetic Foot Ulcers

Abstract

Debridement is an essential part of chronic wound management. Various methods of debridement include sharp surgical (using a scalpel, scissors, curette, or other sharp instruments), mechanical (e.g., wet to dry or wet to moist gauze), biologic (i.e., maggots), high-pressure streams of water, autolytic, and enzymatic. Enzymatic debridement using clostridial collagenase ointment (CCO) offers several advantages over less selective methods including sparing normal healthy tissue and continuous rather than episodic debridement activity. Several studies in chronic nonischemic diabetic foot ulcers (DFU) have shown that CCO is at least equal to other methods of debridement in clearance of nonviable tissue and achieving a clean, granulated wound bed but is consistently better in terms of reducing ulcer size during the initial 4–6 weeks of use. Laboratory and clinical data also suggest that CCO promotes healing through stimulation of cellular migration and proliferation, angiogenesis, and modulation of the inflammatory status of DFU. Limited clinical data also indicate that the incidence of infection for DFU treated with CCO is no worse than for those treated with silver products and better than for those treated with non-active hydrogel dressings.