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- Title
Sharp wound debridement in the management of recalcitrant, locally infected chronic venous leg ulcers: A narrative review.
- Authors
White, Wendy
- Abstract
Background: Sharp wound debridement has been identified as an essential component of biofilm-based wound care (BBWC) in the management of chronic wounds including chronic venous leg ulcers (CVLUs). Aim: To evaluate the validity of available evidence regarding the role, safety and efficacy of sharp debridement in the management of recalcitrant, locally infected CVLUs. Method: A literature search was conducted between August and September 2010. Evidence was sourced from the Cochrane Database of Systematic Reviews via Ovid, DARE, MEDLINE via OvidSP and CINAHL Plus. Search terms included "skin ulcer", "leg ulcer", "varicose ulcer", "wound pain", "wound infection", "biofilms", "debridement", "conservative sharp debridement". The search was restricted to adult, human subjects and articles published in English. The search was limited to articles published between 1999 and 2010. Results: A Cochrane Systematic Review (protocol) was identified, with the review yet to be published on the effect of debridement on CVLU healing. Only three studies including a prospective, cohort study examining the effectiveness and feasibility of sharp debridement for CVLUs in the out-patient setting, a retrospective analysis of two randomised controlled trials (RCTs) examining the impact of serial sharp debridement on both CVLUs and diabetic foot ulcers (DFUs) and a report of four experimental models examining the effect of debridement on in vitro, in vivo and in situ (CVLUs) biofilms were identified. Conclusion: Current high levels of evidence in the form of systematic reviews and large, well-designed RCTs are lacking at the time of this review. Ethical considerations in utilising RCTs to address clinical questions relating to debridement may have an impact on the design of future studies. Some low-level evidence exists, indicating sharp debridement may have an important role to play when undertaken as part of a multifaceted approach to the management of CVLU local infections (a biofilm), in combination with standard care. In this new and emerging science, it is proposed that a paradigm shift in current thinking will be required by both researchers and clinicians as urgently needed future research is planned and undertaken.
- Subjects
SKIN disease treatment; ULCER treatment; CHRONIC wounds &; injuries; WOUND care; BIOFILMS; CINAHL database; DEBRIDEMENT; INFORMATION storage &; retrieval systems; MEDICAL databases; LEG ulcers; MEDLINE; WOUND infections; SYSTEMATIC reviews; EVIDENCE-based medicine; THERAPEUTICS
- Publication
Wound Practice & Research, 2011, Vol 19, Issue 4, p222
- ISSN
1837-6304
- Publication type
Article