乌鸦传媒

Faster and more complete wound healing was achieved with more frequent debridement regardless of wound type, size, or duration, researchers found.

Weekly or even more frequent debridement -- the removal of necrotic tissue and foreign bodies from a wound that isn't healing on its own -- resulted in shorter healing times for all wound types compared with less frequent debridement (P<0.001), according to Scott Covington, MD, of Healogics in Jacksonville, Fla., and colleagues.

Higher frequency debridement improved healing outcomes with shorter healing times, while longer intervals between debridement of wounds were associated with longer treatment times and slower healing resulting in a hazard ratio of 4.26 (95% CI 4.20-4.31). These results were consistent with those found in previous studies, the researchers reported online in JAMA Dermatology.

"The more frequent the debridements, the better the healing outcome," Covington and colleagues wrote.

In an associated commentary, Elizabeth Lebrun, MD, and Robert S. Kirsner, MD, PhD, of the University of Miami, suggested an integrated approach to wound care.

Education and training for proper debridement practices should not be limited to physicians but should include general staff members in order to make the flow of wound care more efficient in dermatology practices, Kirsner and Lebrun indicated.

For optimal wound care, staff should track wound size through measurements or photographs, which can be uploaded into electronic medical records. Alerts can be installed for wounds that do not improve and require advanced therapies, they added.

Data from the study came from Healogics, a for-profit provider of wound care services at 525 locations nationwide. Covington and colleagues analyzed records from 2008 to 2012 for a total of 154,644 patients with 312,744 wounds from all causes. Patients were 47.1% male with a median age of 69 years (age range 19 to 112).

The majority of patients, 59.2%, had only one wound, but 16.4% had two wounds, 7.9% had three wounds, 4.7% had four wounds and 11.7% had five or more wounds. None of the patients in this study had received any advanced therapeutic treatments.

Wound types were simplified into 32 classifications with the majority of wounds fitting into the following categories: arterial ulcer, compromised skin graft/flap, dehisced surgical wound, diabetic foot ulcers (DFU), inflammatory ulcer, pressure ulcer (PU), surgical wound, trauma, ulcer secondary to infection, and venous leg ulcers (VLU).

VLUs were the most common, accounting for 26.1% of wounds, followed by DFUs at 19.0%, and pressure ulcers at 16.2%. The largest wounds were found among skin grafts/flaps, surgical wounds, and traumatic wounds (medians 2.8, 2.88, and 2.85 cm², respectively).

The deepest wounds occurred in surgical and dehisced surgical wounds (median 0.5 cm). The oldest wounds tended to be skin grafts/flaps (median 36 days) and arterial ulcers (median 30 days).

A healed wound was defined as complete epithelialization. Overall, 70.8% of wounds were recorded as having healed. The highest rate of healing occurred in traumatic wounds at 78.4%, and the lowest rate was found among pressure ulcers at 56.6%. The median number of debridements was two across the sample (range 1 to 138), but it varied considerably among different wound types.

For DFUs, median time to heal after weekly or more frequent debridement was 21 days. When debridement frequency was in the range of every 1 to 2 weeks, healing time increased to 64 days. And when wounds were debrided no more than once every 2 weeks or more, healing time increased to 76 days (P<0.001).

Traumatic wounds were different. The median time to heal after weekly or more frequent debridement was 14 days. Debridement every 1 to 2 weeks increased the healing time to 42 days, and to 49 days for debridement every 2 weeks or more (P<0.001).

Male gender was slightly but significantly associated with decreased time to heal (HR 1.03, 95% CI 1.02-1.04). Vascular surgeons were found to debride less often than podiatrists and family physicians.

Nearly twice as many VLUs and DFUs healed completely with frequent debridement compared with those treated less frequently, 50% versus 28% for VLUs and 30% versus 13% for DFUs, respectively.

Previous research supported frequent debridement for improved healing in VLU and DFU wounds, Covington and colleagues noted.

"It can be a question of how often a patient is willing to come in for debridement. It's a challenge to get some people to come in at all. Motivated people tend to do much better," said plastic surgeon Jeffrey Horowitz, MD, who was not involved with the study, in an interview with 乌鸦传媒.

Horowitz, medical director of the Integrated Wound Healing Center at Franklin Square Medical Center in Baltimore, offered clinical guidance for debridement procedures.

"With debridement itself, be cautiously aggressive, don't be afraid to freshen the edges of wounds, but, of course, you have to know your anatomy -- you want to be safe. You need to know if somebody is on Coumadin [warfarin] or any other kind of blood thinner or if you're near a vessel. Have hemostatic agents handy, silver nitrate, powders, and/or Gelfoam, those things are important to have nearby to stop bleeding," Horowitz continued.