Smith F, Dryburgh N, Donaldson J, Mitchell M, et al.
The Cochrane database of systematic reviews. Date of publication 2013 Sep 5;volume (9):CD006214.
1. Cochrane Database Syst Rev. 2013 Sep 5;(9):CD006214. doi:
10.1002/14651858.CD006214.pub4.
Debridement for surgical wounds.
Smith F(1), Dryburgh N, Donaldson J, Mitchell M.
Author information:
(1)School of Nursing, Midwifery and Social Care, Faculty of Health, Life & Social
Sciences, Edinburgh Napier University, Sighthill Campus, Edinburgh, UK, EH11 4BN.
Update of
Cochrane Database Syst Rev. 2011;(5):CD006214.
BACKGROUND: Surgical wounds that become infected are often debrided because
clinicians believe that removal of this necrotic or infected tissue will expedite
wound healing. There are numerous methods available but no consensus on which one
is most effective for surgical wounds.
OBJECTIVES: To determine the effect of different methods of debridement on the
rate of debridement and healing of surgical wounds.
SEARCH METHODS: In March 2013, for this third update, we searched the Cochrane
Wounds Group Specialised Register; the Cochrane Central Register of Controlled
Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process &
Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL.
SELECTION CRITERIA: We included randomised controlled trials (RCTs) with outcomes
including at least one of the following: time to complete debridement or time to
complete healing.
DATA COLLECTION AND ANALYSIS: Two review authors independently reviewed the
abstracts and titles obtained from the search, extracted data independently using
a standardised extraction sheet and independently assessed methodological
quality. One review author was involved in all stages of the data collection and
extraction process, thus ensuring continuity.
MAIN RESULTS: Five RCTs (159 participants) were eligible for inclusion; all
compared treatments for infected surgical wounds and reported time required to
achieve a clean wound bed (complete debridement). One trial compared an enzymatic
agent (streptokinase/streptodornase) with saline-soaked dressings. Four trials
compared the effectiveness of dextranomer beads or paste with other products
(different comparator in each trial) to achieve complete debridement.
Meta-analysis was not possible due to the unique comparisons within each trial.
One trial reported that dextranomer achieved a clean wound bed significantly more
quickly than Eusol, and one trial comparing enzymatic debridement with
saline-soaked dressings reported that the enzyme-treated wounds were cleaned more
quickly. However, methodological quality was poor in these two trials.
AUTHORS' CONCLUSIONS: There is a lack of large, high-quality published RCTs
evaluating debridement per se, or comparing different methods of debridement for
surgical wounds, to guide clinical decision-making.
DOI: 10.1002/14651858.CD006214.pub4
PMID: 24008995 [Indexed for MEDLINE]
