Wilcox, James R; Carter, Marissa J; Covington, Scott, et al.
JAMA dermatology. Date of publication 2013 Sep 1;volume 149(9):1050-1058.
IMPORTANCE: Chronic wounds usually get trapped in the inflammatory stage of wound healing; however, aggressive debridement transforms chronic wounds to acute wounds and therefore complete healing. OBJECTIVE: To investigate healing outcomes and debridement frequency in a large wound data set. DESIGN: Retrospective cohort study. SETTING: Data collected from 525 wound care centers from June 1, 2008, through June 31, 2012, using a web-based clinical management system. PATIENTS: Referred sample of 154 644 patients with 312 744 wounds of all causes (of an initial data set of 364 534 wounds) participated. A total of 47.1% were male. Median age was 69 years (age range, 19-112 years), with 59.2% having one wound. Eligibility criteria included age older than 18 years, receiving at least 1 debridement, and having been discharged from the system. Advanced therapeutic treatment was ineligible. Because of incomplete, questionable, or ineligible data, 57 190 wounds were not included. Most wounds were diabetic foot ulcers (19.0%), venous leg ulcers (26.1%), and pressure ulcers (16.2%). INTERVENTION: Debridement (removal of necrotic tissue and foreign bodies from the wound) at different frequencies. MAIN OUTCOME AND MEASURE: Wound healing (completely epithelialized with dimensions at 0 × 0 × 0 cm). RESULTS: A total of 70.8% of wounds healed. The median number of debridements was 2 (range, 1-138). Frequent debridement healed more wounds in a shorter time (P < .001). In regression analysis, significant variables included male sex, physician category, wound type, increased patient age, and increased wound age, area, and depth. The odds ratio varied considerably for each variable. CONCLUSIONS AND RELEVANCE: The more frequent the debridements, the better the healing outcome. Although limited by retrospective data, this study's strength was the analysis of the largest wound data set to date.
