Debridement for surgical wounds.

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.

Debridement for surgical wounds.

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 STRATEGY: For this second update we searched the Cochrane Wounds Group Specialised Register (searched 13 April 2011); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 1); Ovid MEDLINE (2007 to March Week 5 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, April 11, 2011); Ovid EMBASE (2007 to 2011 Week 14); and EBSCO CINAHL (2007 to 8 April 2011). 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.

Debridement for surgical wounds.

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: We developed a search strategy to search the following electronic databases: Wounds Group Specialised Trials Register (searched 3/3/08) , Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2008, issue 1), MEDLINE (1950 to February Week 3 2008 ), EMBASE (1980 to 2008 Week 09) and CINHAL (1982 to February Week 4 2008). We checked the citations within obtained studies to identify additional papers and also relevant conference proceedings. We contacted manufactures of wound debridement agents to ascertain the existence of published, unpublished and ongoing trials. Our search was not limited by language or publication status. 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 debridement per se or comparing different methods of debridement for surgical wounds, to guide clinical decision making.