Background

Venous leg ulcers are a common type of leg wound. They can cause pain, stress, social isolation and depression. These ulcers take approximately 12 weeks to heal and the best and first treatment to try is compression bandages. In an attempt to improve the healing process it is thought that removing dead or dying tissue (debridement) from the surface of the wound can speed up healing. Six different methods can be used to achieve debridement: use of an instrument such as a scalpel (with or without anaesthesia - surgical debridement and sharp debridement, respectively); washing solutions and dressings (mechanical debridement); enzymes that break down the affected tissue (enzymatic debridement); moist dressings or natural agents, or both, to promote the wound's own healing processes (autolytic debridement); or maggots (biosurgical debridement).

Objectives

We assessed evidence from medical research to try to determine how effective these different methods of debridement are in debriding wounds. We also wanted to understand what effect, if any, debridement has on the healing of venous ulcers, and whether any method of debridement is better than no debridement when it comes to wound healing.

Search methods

We searched a wide range of electronic databases and also reports from conferences up to 10 February 2015. We included studies written in any language that included men and women of any age, cared for in any setting, from any country, and we did not set a limit on the years in which studies were published. We were only interested in robust research, and so restricted our search to randomised controlled trials (in which people are randomly allocated to the methods being tested). All trial participants were required to have a venous ulcer with dead tissue (slough) present in the wound.

Results

We found ten studies that included a total of 715 participants. These were conducted in a range of countries and care settings. Participants had an average age of 68 years, and there were more women than men. Most of the studies were small, with half of them having fewer than 67 participants. The trials tested a range of debridement methods including: autolytic methods such as non-adherent dressings; very small beads; biocellulose dressings; honey; gels; gauze and methods using enzymes. Autolytic methods of debridement, were the most frequently tested. We identified no studies that tested surgical, sharp or mechanical methods of debridement and no studies that tested debridement against no debridement.

It was not possible to say whether any of the methods evaluated performed better than the rest. There was some evidence to suggest that sloughy ulcers that had more than 50% of slough removed after four weeks were more likely to heal by 12 weeks; and some evidence to suggest that ulcers debrided using honey were more likely to heal by 12 weeks than ulcers debrided with hydrogel. What remains uncertain at this time is whether debridement itself, or any particular form of debridement is beneficial in the treatment of venous ulcers.

The overall quality of the evidence we identified was low, as studies were small in size, and most were of short duration. There were differences between them in terms of the amount of slough in the wound bed of the ulcers at the start of the trial, in treatment regimes, the duration of treatments, and the methods used to assess how well the debridement treatments had worked. In six trials, the people assessing the wounds were aware of the type of treatment each patient was receiving, which may have affected the impartiality of their evaluations. Five studies did not provide information on all the results (outcomes) in their trials, and this missing information on important benefits or harms of the debridement method being evaluated meant that those trials were at a high risk of bias and of producing unreliable results. Only two studies reported side effects due to the treatment; these included maceration (or wetness) of the skin around the ulcers, infection and skin inflammation.