Frequent debridement of chronic wounds is associated with improved healing, according to James Wilcox, RN, lead author of a retrospective study of more than 300,000 wounds. Diabetic foot ulcers accounted for a large percentage of these wounds.
“An effective healing strategy for chronic wounds should include an early and accurate diagnosis of wound etiology, as well as the appropriate application of debridement and advanced healing modalities in an effort to achieve optimal outcomes,” said Mr. Wilcox, who is Director of Research and Quality for Medical Affairs at Healogics in Jacksonville, FL, and Immediate Past President of the Baromedical Nurses Association.
“If standard care fails to reduce wound size by 40% to 50% in 4 weeks, referral to wound experts should be initiated,” said Mr. Wilcox, whose study was published in a recent issue of JAMA Dermatology.
“While a randomized clinical trial evaluating debridement for diabetic foot ulcers has never been performed, secondary analysis of trials performed for other reasons suggested that debridement is beneficial,” commented Robert S. Kirsner, MD, PhD, Professor, Vice Chairman and Stiefel Laboratories Chair, Department of Dermatology and Cutaneous Surgery, and Chief of Dermatology University of Miami School of Medicine.
“Those analysis have also suggested that centers that debrided more often had better results. This data by Wilcox et al provides confirmatory effectiveness data,” he said.
“The size of the data set and the number of wounds treated provides informative results and are strengths of the study,” Dr. Kirsner told DiabeticLifestyle.com. The findings suggest that debridement “should be part of the standard of care and repetitive debridement may be beneficial as well,” he said.
Mr. Wilcox and colleagues analyzed data on 312,744 wounds treated with at least 1 debridement among 154,644 adult patients from more than 500 wound care centers in the United States. None of the wounds were treated with advanced therapeutics. The wounds were most commonly venous leg ulcers (26.1%), diabetic foot ulcers (19.0%), and pressure ulcers (16.2%).
Nearly two-thirds of the wounds healed (71%), and the median number of debridements was 2 (range 1-138). Wounds that were treated with weekly debridement or more frequently had a significantly shorter healing time (hazard ratio [HR], 4.26; P<0.001). This relationship was found for all wound types, but varied slightly in degree. For diabetic foot ulcers, wounds treated weekly or more often healed at 21 days compared with 64 and 76 days for wounds treated less frequently, respectively (P<0.001).
Male gender also was associated with a shorter healing time (hazard ratio [HR], 1.03). In contrast, increased area, depth, and age of the wound as well as older age were linked to a longer time to heal.
“One must take caution because quality of debridement was not studied nor were the effects of weekly visits to specialized wound centers controlled for,” said Dr. Kirsner. “Therefore it is possible that a well-done debridement performed initially may be as effective as less well done multiple debridements. It is also possible that other things that occur at specialized wound centers with compliant patients who come weekly for their visits may be an important factor in the results observed in the study,” he noted.
Wilcox JR, Carter MJ, Covington S. Frequency of Debridements and Time to Heal: A Retrospective Cohort Study of 312 744 Wounds. JAMA Dermatol. 2013 Jul 24. doi: 10.1001/jamadermatol.2013.4960.