Debridement for surgical wounds

Citation

Dryburgh N, Smith F, Donaldson J & Mitchell M (2008) Debridement for surgical wounds. Cochrane Database of Systematic Reviews, 2008 (3), Art. No.: CD006214. https://doi.org/10.1002/14651858.CD006214.pub2

Abstract
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  The aim of this review is to determine the effect of different methods of debridement on the rate of debridement and healing of surgical wounds.  Search strategy  For this first update we searched the Cochrane Wounds Group Specialised Register (searched 9 September 2010); The Cochrane Central Register of Controlled Trials (CENTRAL) -The Cochrane Library2010 Issue 3; Ovid MEDLINE (2007 to September Week 1 2010); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, September 10, 2010); Ovid EMBASE (2007 to 2010 Week 34); and EBSCO CINAHL (2007 to 3 September 2010).  Selection criteria  We included relevant randomised controlled trials (RCT) with outcomes including at least one of the following: time to complete debridement, or time to complete healing.  Data collection and analysis  Two authors independently reviewed the abstracts and titles obtained from the search, two extracted data independently using a standardised extraction sheet, and two independently assessed methodological quality. One author was involved in all stages of the data collection and extraction process, thus ensuring continuity.  Main results  Five RCTs 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 and reported the time to complete debridement. Four of the 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 debridementper seor comparing different methods of debridement for surgical wounds, to guide clinical decision making.

Journal
Cochrane Database of Systematic Reviews: Volume 2008, Issue 3