Debridement Of Chronic Wounds Research Articles

Harnessing the sweet potential: the revival of honey dressing in modern wound care

Honey dressings have found wide application in the past and are currently experiencing a resurgence due to their beneficial properties, which aid professionals in their daily practices. Manuka honey possesses properties that are suitable for debridement of chronic wounds, stoma-therapy, and burns. This cultural article aims to review the major literature and benefits of medical honey dressing and underline five important implications (i.e., alternative care for individuals experiencing antibiotic resistance, ease of application, faster healing, shorter hospital stays, and economic convenience in countries characterized by high financial constraints) that at this stage are underdeveloped in the literature.

The Role of Maggot Debridement Therapy in Wound Healing

Abstract The upward trend of diabetes and its complications had taken a big toll on developing countries where big budgets are allocated to manage it. Diabetes-based foot ulcerations has become a nightmare for patients and equally the clinicians due to its chronicity and devastating complications. Diabetic foot ulcers (DFU) take a long time to heal and generally resistant to conventional methods. DFU are commonly associated with high numbers of foot complications such as infection, gangrene and lower limb amputations. Despite the technological advancement in chronic wound management, the numbers of preventable foot complications especially amputations of toes and limb are still in the upward trend as the number of diabetics increases across the globe. Alternative method using sterile maggots of Lucilia spp has been much talked about for the past few decades to improve wound healing outcomes and ultimately reduce foot complications. Maggot debridement therapy, commonly known as MDT has been widely used as an alternative tool in the debridement of chronic wounds to remove slough, necrotic tissue from the wound bed. The usage of MDT has produced significant debridement and healing outcomes in diabetic foot ulcers and has been shown to reduce infections and stimulate healing. Despite numerous findings pointing to the relevance of MDT in the treatment protocol of chronic wounds especially DFU, MDT remains as the last resort in the process of salvaging limbs.

Position paper of the Initiative Chronische Wunde (ICW) e. V. on the nomenclature of debridement in chronic wounds

Die heute in der Wundbehandlung verwendete Nomenklatur ist interdisziplinär und interprofessionell sehr unterschiedlich. Daher ist es ein Anliegen der Fachgesellschaft Initiative Chronische Wunde (ICW) e. V. bislang unklare Begriffe eindeutig und nachvollziehbar zu beschreiben. Von den Experten der ICW wurde daher in einem Konsensusverfahren als Débridement chronischer Wunden die Entfernung von anhaftendem, abgestorbenem Gewebe, Krusten oder Fremdkörpern aus Wunden bezeichnet. Hierfür gibt es verschiedene Therapieoptionen, die als autolytisches, biochirurgisches, mechanisches, osmotisches, proteolytisches/enzymatisches und technisches Débridement unterschieden werden können. Bei dem chirurgischen Débridement wird zudem zwischen meist ambulant durchführbaren scharfen Débridements wie beispielsweise kleineren chirurgischen Eingriffen und chirurgischen Débridements mit adäquater Anästhesie in einem Operationssaal differenziert. Als Wundspülung wird von der ICW die Entfernung von nicht haftenden Bestandteilen auf Wunden mit sterilen Lösungen bezeichnet.Débridement und/oder Wundspülung sind oft der erste Schritt einer phasengerechten modernen Wundbehandlung. Mehrere Methoden eignen sich für die Anwendung einer kombinierten oder sukzessiven Therapie. Bei der Entscheidung, welche therapeutische Option hierbei zum Einsatz kommt, sollte eine Vielzahl individuell unterschiedlicher Faktoren in Abhängigkeit von den zu behandelnden Patienten, aber auch von den Therapeuten berücksichtigt werden. Die letztendliche individuelle Entscheidung für eine Methode sollte jeweils gemeinsam mit den Patienten getroffen und anschließend adäquat dokumentiert werden.

Bromelain‐based enzymatic debridement of chronic wounds: Results of a multicentre randomized controlled trial

Chronic wounds are estimated to affect over 6 million people annually in the United States with an estimated annual cost of $25 billion. Debridement represents a key step in their management and is considered a basic necessity to induce the functional process of tissue repair. However, there is an unmet need for an efficient rapid acting non-surgical debridement agent. Bromelain-based enzymatic debridement has been proven to provide an effective, selective and safe non-surgical debridement in deep burns. EscharEx (MediWound Ltd, Yavne, Israel), is a bromelain-based enzymatic debridement agent currently in development for chronic wounds. The aim of this study was to assess its safety and efficacy in chronic wounds. Seventy-three patients suffering from a lower extremity ulcer of diabetic/venous insufficiency/post-surgical/traumatic aetiology were enrolled in a multicentre, assessor blinded, randomized controlled trial. Patients were randomized to topical treatment by either EscharEx or its gel vehicle for up to 10 daily 4 hour applications, and then continued follow-up for up to 6months. The EscharEx arm achieved a significantly higher incidence of complete debridement compared to the gel vehicle arm; 55 versus 29% (p= .047), thus meeting the primary endpoint of this study. The EscharEx and gel vehicle arms achieved similar reductions in wound area, non-viable tissue area and wound healing scores during the debridement period. There were no significant differences between the arms in the incidence of complete wound closure (41% in the EsxcharEx arm vs. 53% in the gel vehicle arm) and in the mean time to complete wound closure (70.0± 32.8 days in the EsxcharEx arm vs. 65.7± 38.4 days in gel vehicle arm). There were no significant safety issues and EscharEx demonstrated a favourable benefit to risk profile.

Efficacy of Versajet hydrosurgery system in chronic wounds: A systematic review.

Studies demonstrating the effectiveness of hydrosurgery for chronic wounds are extremely limited. This systematic review aimed to evaluate the efficacy of hydrosurgery compared with conventional debridement in chronic wounds, skin ulcers, and non‐acute wounds. This PROSPERO‐registered review was performed following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement. A systematic search was performed in PubMed, Scopus, and Cochrane Library databases. s of all studies were screened independently by two reviewers. The bias of prospective randomised controlled studies was assessed using the Cochrane Collaboration's tool for assessing the risk of bias and RevMan 5.4 software, whereas the bias of retrospective comparative studies was evaluated using the Risk of Bias Assessment Tool for Non‐randomised Studies. Two prospective randomised controlled trials, two retrospective comparative studies, and three prospective non‐comparative studies were included. Hydrosurgery enabled rapid debridement. The Versajet Hydrosurgery System saved 8.87 minutes compared with the conventional methods. Similarly, the debridement quality was high with this system. The debridement number needed to achieve adequate wound beds was fewer in the hydrosurgery group than in the conventional group. These superiorities lead to subsequent success and cost‐effectiveness. As there were only two prospective randomised controlled studies, and much information was missing, the risk of bias was unclear. This review confirmed that hydrosurgery is useful for the debridement of chronic wounds, considering the procedural speed and quality.

Effectiveness of ultrasonic debridement on reduction of bacteria and biofilm in patients with chronic wounds: A scoping review.

Chronic wounds are defined as “hard‐to‐heal” wounds that are caused by disordered mechanisms of wound healing. Chronic wounds have a high risk of infection and can form biofilms, leading to the release of planktonic bacteria, which causes persistent infections locally or remotely. Therefore, infection control and removal of the biofilm in chronic wounds are essential. Recently, ultrasonic debridement was introduced as a new method to reduce infection and promote the healing of chronic wounds. This scoping review aimed to evaluate the effectiveness of ultrasonic debridement on the changes in bacteria and biofilms, and consequently the wound healing rate of chronic wounds. A total of 1021 articles were identified through the database search, and nine papers were eligible for inclusion. Findings suggest that non‐contact devices are useful for wound healing as they reduce the inflammatory response, although the bacterial load is not significantly changed. Ultrasonic debridement devices that require direct contact with the wound promote wound healing through reduction of biofilm or bacterial load. The optimum settings for ultrasonic debridement using a non‐contact device are relatively consistent, but the settings for devices that require direct contact are diverse. Further studies on ultrasonic debridement in chronic wounds are required.

Combined debridement in chronic wounds: A literature review

Abstract Wounds debridement is important for healing of chronic wounds. Combined debridement is a new technique to deal with the complex chronic wounds. This review introduces several topical methods of combined debridement according to the various color classifications. Methods include combined sharp and hydrogel debridement, combined ultrasonic and enzymatic debridement, ultrasonic debridement combined with surgical debridement and vacuum aspiration on debridement, and other types of debridement. This article also explores why each combined debridement mentioned above can achieve a good effect.

Combined debridement in chronic wounds: A literature review

Combined debridement in chronic wounds: A literature review

Effect of a wound cleansing solution on wound bed preparation and inflammation in chronic wounds: a single-blind RCT.

Research into surfactant solutions for the debridement of chronic wounds suggests that surfactants may support wound bed preparation (WBP) in chronic wounds, however their efficacy has not been evaluated in randomised controlled trials (RCTs). Our aim was to assess the clinical efficacy of a propylbetaine-polihexanide (PP) solution versus normal saline (NS) solution in WBP, assessing inflammatory signs and wound size reduction in patients with pressure ulcers (PUs) or vascular leg ulcers. In a single-blinded randomised controlled trial (RCT) patients were randomly allocated to two groups and treated with either propylbetaine-polihexanide (PP) solution (Prontosan) or NS. Wounds were assessed using the Bates-Jensen wound assessment tool (BWAT). Assessments took place at inclusion (T0), day 7 (T1), day 14 (T2), day 21 (T3), and day 28 (T4). Outcomes were analysed using a two-tailed Student's t-test. A total of 289 patients were included. Both groups had similar demographics, clinical status, and wound characteristics. Data analysis showed statistically significant differences between T0 and T4 for the following outcomes: BWAT total score, p=0.0248; BWAT score for inflammatory items, p=0.03; BWAT scores for wound size reduction (p=0.049) and granulation tissue improvement (p=0.043), all in favour of PP. The assessment of pain did not show any significant difference between the two groups. The study results showed significantly higher efficacy of the PP solution versus NS solution, in reducing inflammatory signs and accelerating the healing of vascular leg ulcers and PUs. This evidence supports the update of protocols for the care of chronic wounds. The authors have no conflict of interest regarding this research. This is an investigator initiated trial. B. Braun Milano SpA kindly provided the material under investigation for both treatment groups, and paid the Ethics Committees' application fees in all participating centres.

Collagenase Ointment for the Debridement of Chronic Wounds

Journal of Wound, Ostomy and Continence Nursing: November 2009 - Volume 36 - Issue 6S - p S2-S3 doi: 10.1097/WON.0b013e3181c03534

Surgical Pathology to Describe the Clinical Margin of Debridement of Chronic Wounds Using a Wound Electronic Medical Record

Chronic wounds, including diabetic foot ulcers (DFU), pressure ulcers (PU), and venous ulcers (VU) result from multiple physiologic impairments. Operative debridement is a mainstay of treatment to remove nonviable tissue and to stimulate wound healing. Unlike tumor resection, however, operative wound specimens are not routinely sent for pathology. The objective of this study was to describe the pathology present in chronic wounds. Pathology reports of the skin edge and wound base from 397 initial debridements in 336 consecutive patients with chronic wounds were retrospectively reviewed. All data were entered and stored in a Wound Electronic Medical Record. Pathology data were extracted from the Wound Electronic Medical Record, coded, and quantified. Up to 15 distinct histopathologic findings across 7 tissue types were observed after review of pathology reports from chronic wounds. Specifically, the pathology of epidermis revealed hyperkeratosis: 66% in DFUs, 31% in PUs, and 29% in VUs. Dermal pathology revealed fibrosis in 49% of DFUs, 30% of PUs, and 15% of VUs. Wound bed pathology revealed necrosis in the subcutaneous tissue in 67% of DFUs, 55% of PUs, and 19% of VUs. Fibrosis was reported in between 19% and 52% of all wound types. Acute osteomyelitis was present in 39% of DFUs, 33% of PUs, and 29% of VUs. This observational study of the histopathology of initial surgical debridement of chronic wounds revealed a wide range of findings across multiple tissue levels. Although certain findings such as osteomyelitis and gangrene have been shown to directly relate to impaired wound healing and amputation, other findings require additional investigation. To rigorously define a margin of debridement, a prospective study relating histopathology and clinical outcomes such as healing rates and amputation is needed.

Using Gene Transcription Patterns (Bar Coding Scans) to Guide Wound Debridement and Healing

To acquaint wound care practitioners with new information related to debridement of chronic wounds. This continuing education activity is intended for physicians and nurses with an interest in wound care. After reading this article and taking this test, the reader should be able to: 1. Explain the role of keratinocytes in wound healing. 2. Discuss new research findings on the physiological differences between healing and nonhealing wounds.3. Identify implications of the new research for debridement of chronic wounds.

Guidelines for the treatment of venous ulcers

1. Co-chaired this panel2. University of South Florida, Tampa, FL3. Healthpoint Ltd., Fort Worth, TX4. University of California, San Francisco, CA5. University of Texas Medical Branch, Galveston, TX6. University of Cardiff, Cardiff, Wales, UK7. University of Pennsylvania, Philadelphia, PA8. Private practice, Warren, PA9. Private practice, Tamarac, FL10. University of Pittsburgh, Pittsburgh, PA11. St. Louis University, St. Louis, MO, and12. Washington University, St. Louis, MO

Evaluation of Clinical Effectiveness of MIST Ultrasound Therapy for the Healing of Chronic Wounds

(1) To determine the incidence of wound closure for chronic nonhealing lower extremity wounds of various etiologies using MIST ultrasound therapy, a 510(K)-approved, low-frequency, noncontact ultrasound device indicated for the cleansing and debridement of chronic wounds. (2) To determine the optimum treatment duration for therapy with this low-frequency, noncontact ultrasound device, quantifying end points that correlate with a maximal clinical response and identifying potential synergistic therapies that could be used in conjunction with this therapy. (3) To analyze the impact of low-frequency noncontact ultrasound therapy on the microcirculatory flow patterns within the wound bed. A noncomparative clinical outcomes trial utilizing low-frequency, noncontact ultrasound. A tertiary-referral hospital-based wound clinic. Twenty-three patients from a single tertiary-referral hospital-based wound clinic. Control data were obtained from a previously published, prospectively collected database from the same clinic. During an 8-month period, a total of 29 lower extremity wounds in 23 patients who met criteria for inclusion were treated with low-frequency, noncontact ultrasound therapy. Standard of care was provided for 2 weeks for all wounds screened for the study. A failure to achieve an area reduction greater than 15% qualified the patient for enrollment to the trial and the addition of low-frequency, noncontact ultrasound therapy to the current treatment regimen. Wound healing, area and volume reduction, and laser Doppler-derived mean voltage (a marker for microcirculatory flow) are the main outcome measures for the study. Overall, 69% of the wounds in the study were healed using an intent-to-treat model. When low-frequency, noncontact ultrasound was used as a stand-alone device, median time to healing was 7 weeks. Historic controls were healed with a median time to healing of 10 weeks; however, a statistically significant number of these patients required wound-related hospitalization and surgical procedures to achieve closure compared with the wounds in the present study. Treatment with low-frequency, noncontact ultrasound achieved healing in chronic wounds when used as a stand-alone device or in combination with moist wound care in 69% of cases. Response to low-frequency, noncontact ultrasound was evident within 4 weeks of therapy. Earlier transition to secondary procedures and decreased utilization of inpatient care might result in more cost-effective wound healing than the current standard of care. A well-designed health economic-based trial is warranted to assess this technology.

Do Topical Analgesics Reduce Pain Associated With Wound Dressing Changes or Debridement of Chronic Wounds?

Do Topical Analgesics Reduce Pain Associated With Wound Dressing Changes or Debridement of Chronic Wounds?

Optionen des Debridements in der Therapie chronischer Wunden

ZusammenfassungDas Debridement ist definiert als Entfernung von nicht‐vitalem Gewebe aus einer Wunde. In chronischen Wunden wird mit dem Debridement die Elimination von Nekrosen, aber auch die Abtragung von Verbandresten, Fremdkörpern oder anderen avitalen Bestandteilen bezeichnet. Das sachgerechte Debridement stellt eine grundlegende Voraussetzung für den Ablauf eines nicht verzögerten Wundheilungsprozesses dar. Eingebunden in Überlegungen zur Therapie der zugrunde liegenden Ursachen einer verzögerten Wundheilung sollte das Debridement den ersten Schritt in einer adäquaten Phasen‐adaptierten Wundgrund‐Konditionierung chronischer Wunden darstellen.Dieser Beitrag soll eine Übersicht über die unterschiedlichen Optionen der Durchführung eines Debridements in der Therapie chronischer Wunden bieten. Für die Durchführung eines Debridements chronischer Wunden eignen sich als therapeutische Maßnahmen Chirurgie, Biochirurgie, Laser, Ultraschall, Hydrotherapien, Naß‐zu‐trocken‐Methode, Autolyse, proteolytische Enzyme, osmotisches‐ oder chemisches‐Debridement.Das einzig richtige Debridement gibt es nicht! So individuell die Patienten und die Ursachen der zugrunde liegenden Wundheilungsstörungen sind, so unterschiedlich sinnvoll kann auch der Einsatz der verschiedenen Methoden der Durchführung eines Debridements sein. Für welche therapeutische Option man sich entscheidet, wird durch eine Vielzahl von Faktoren bestimmt. Darüber hinaus kann auch die sukzessive Verwendung unterschiedlicher Methoden je nach Zusammensetzung des Wundmilieus sinnvoll sein.

Debridement of Chronic Wounds: A Nursing Perspective

Debridement of Chronic Wounds: A Nursing Perspective

The debridement of chronic wounds: a systematic review.

The debridement of chronic wounds: a systematic review.