Smith RG
Ostomy/wound management. Date of publication 2008 Aug 1;volume 54(8):16-34.
1. Ostomy Wound Manage. 2008 Aug;54(8):16-34.
Enzymatic debriding agents: an evaluation of the medical literature.
Smith RG(1).
Author information:
(1)Shoe String Podiatry, 723 Lucerne Circle, Ormond Beach, FL 32174, USA.
Robert.Smith@FHMD.org
Although debridement is an essential part of wound care, information to guide
evidence-based decisions is limited in the literature. Assuming studies to
ascertain the effectiveness of pharmaceutically based enzymatic debridement
products are more prolific than studies using nonpharmaceutical debridement
options, a literature review was conducted to provide an evidence base to justify
current wound care practice. Information on collagenase- and papain-urea-based
products was reviewed with emphasis on their functional components, mechanisms of
action, and patient considerations. The Medline Database, Cochrane Database of
Systematic Reviews, InfoPOEMs, Institute for Clinical Systems Improvement,
National Guideline Clearinghouse, and Primary Care Clinical Practice Guidelines
were searched for documents published between 1967 and 2007 using the following
terms: enzymatic debridement, collagenase, papain-urea, papain-urea chlorophyllin
copper complex, wounds, and diabetic foot wounds. Sixteen of of 44 relevant
citations obtained fit the established criteria for readability, accuracy,
reliability and validity of information. Four of the 16 studies included a
control treatment, the external validity of 13 studies was limited due to small
sample size, and only four studies reported a statistically significant
difference in treatment outcome. Predicted bias and publication bias were common.
Of the studies detailed herein, three qualified as A level, 13 qualified as B
level, and none were considered to provide C level evidence. Although clinicians
can glean practical information from the homogenized findings regarding patient
demographics, wound type, and therapeutic goals, future studies designed to meet
the criteria of level A evidence are needed to provide evidence for the use of
enzymatic debridement agents.
PMID: 18716339 [Indexed for MEDLINE]
