SLR - July 2014 - Dipon Patel

Frequency of Debridements and Time to Heal: A Retrospective Cohort Study of 312,744 Wounds

Reference: Wilcox JR, Carter MJ, Covington S. Frequency of Debridements and Time to Heal.
A Retrospective Cohort Study of 312,744 Wounds. JAMA Dermatol. 2013 Sep; 149(9):1050-8.

Scientific Literature Review

Reviewed By: Dipan Patel DPM
Residency Program: NSLIJ Forest Hills Hospital

Podiatric Relevance: The purpose of this retrospective study was to study different types of wounds including venous stasis ulcers, diabetic ulcers, traumatic wounds, dehisced surgical wounds and pressure ulcers, and to evaluate healing outcomes and debridement frequencies in 154,644 patients.
 
Methods: This was retrospective study involving large patient pool of 154,644 patient with 312,744 wounds of different types. A total of 52.9 percent included patients were female and 47.1 percent were male. Eligibility criteria was at least age of 18 years or older and receiving at least one debridement. Median age was 69 years (range 19-112 years). The data collected from entire study was analyzed from June 1, 2008 through June 31, 2012. They used web based clinical management system to analyze all the data. Patients receiving advanced therapy like hyperbarics were excluded from the study. Majority of ulcers studied in this large set of study were venous stasis ulceration, comprising about 26 percent.

Results: About 70 percent of wounds healed performing debridement with mean debridement frequency of 2 (range 1-138). Although there was a significant difference among wound types because the data set was very large, in general, no remarkable differences were found in the proportions of wounds receiving different debridement frequencies except that compromised skin flaps/grafts had a higher proportion receiving weekly or higher frequency debridement.

Conclusions: We all know that most of the time chronic wounds get trapped in the inflammatory stage of wound healing, and with aggressive debridement we can transform chronic wounds into acute wounds which are arrested in chronic phase of wound healing. This study supports debridement as part of the treatment of chronic wounds.

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