Debridement: systematic review

Author (s)StudyType of interventionSetting and locationNumbers randomisedInclusion criteria/Exclusion criteriaMean age±SD (years) Male/female ratio EthnicityFollow-up periodMain outcome measures
Smith J, 2002Meta-analysis of 3 studies hydrogel compared with gauze or good wound care, outcome number of ulcers completely healed5 RCTs (3 assessed effectiveness of a hydrogel, 1 evaluated surgical debridement, 1 evaluated larval therapy vs a hydrogel)

Test for heterogeneity NS
Outpatient s 2 studies, rest unreported29–172 (31, 42,140)

Groups balanced at baseline demonstrate d in 2 studies. Blinded outcome demonstrate d in 1 study. Losses to FU reported in 4 studies
Inclusion: Type 1 or Type 2, active foot ulcer of neuropathic, neuroischaemic, or ischaemicaetiology, RCTsPrimary : (all 5 studies) wound closure (time taken, or proportions of wounds achieving complete would closure)
Secondary: healing rates (3 studies)
Results
RR (95% CI) RR 1.84 (1.30, 2.61), n=51/99 hydrogel, 28/99 gauze or good wound care

Systematic review comments: studies small and of poor methodological quality. Evidence suggests that hydrogel increases healing of diabetic foot ulcers compared with gauze or standard wound care. Not clear if this effect is due to debridement.
Notes
Smith J. Debridement of diabetic foot ulcers (Cochrane Review). In: The Cochrane Library, Issue 4, 2002. Oxford: Update Software

Note: Search up to January 2000 so need any RCT published on debridement between February 2000 and October 2002
Saap & Falanga 2002FOR OTHER TABLES, AN INTERVENTION FOR ALL DIABETIC FEETValidation of a scoring system – DPI (Debridement Performance Index) to assess performance and adequacy of debridement in diabetic foot ulcers using patients in a controlled randomised trial
T1: Bilayered biogengineered skin graft, up to 5 applications in 4 weeks
T2: standard care –twice daily moist gauze dressings, offloading

Photographs taken pre and post debridement and scored at day 0
143 patient digital photographs from
T1: 78
T2: 65
Inclusion: Diabetes, Type 1 or 2, 18–80 years of age, HbA1c 6–12%, full thickness neuropathic ulcers (excluding dorsum of foot and calcaneus) 2 weeks, postdebridement ulcer size 1–16cm2, audible dorsalis pedis and posterior tibia pulses.
Exclusion: Clinical infection at study sight, ABI<0.65, absent pulses, active Charcot’s disease, non-diabetic ulcer, other conditions that impair wound healing.
6 months
Results
Significant association between Debridement Performance Index and complete healing in T1 and T2 (p=0.0276) and significant trend with lower score and lower incidence of complete wound closure (p=0.0341).
Patients with a score of 3–6 were 2.4 times more likely to heal than those with a score of 0–2. With control for treatment received, the Debridement Performance Index was an independent predictor of wound closure OR 2.4, 95% CI 1.0, 5.6.

From: Appendix 9, Debridement

Cover of Clinical Guidelines for Type 2 Diabetes
Clinical Guidelines for Type 2 Diabetes: Prevention and Management of Foot Problems [Internet].
NICE Clinical Guidelines, No. 10.
School of Health and Related Research (ScHARR), University of Sheffield.
Sheffield (UK): University of Sheffield; 2003.
Copyright © 2003, School of Health and Related Research (ScHARR), University of Sheffield.

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