Debridement for surgical wounds

Following surgery most surgical wounds heal naturally with no complications. However, complications such as infection and wound dehiscence (opening) can occur which may result in delayed healing or wound breakdown. Infected surgical wounds may contain dead (devitalised) tissue. Removal of this dead tissue (debridement) from surgical wounds is believed to enable wound healing. Many methods are available to clinicians to debride surgical wounds. This review showed that there is insufficient valid research evidence to recommend any one particular method.

There is a clear need for more research into which method is most effective in removing dead tissue from surgical wounds that have become infected.

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.

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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: 

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.

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