title: Effect of sharp debridement using curette on recalcitrant nonhealing venous leg ulcers: a concurrently controlled, prospective cohort study.
abstract: The objective of this study was to evaluate the effect of sharp debridement on the progression of recalcitrant chronic venous leg ulcers (CVLU) and to assess the feasibility of performing this procedure in an outpatient setting. We performed a prospective study of 55 CVLU (53 patients) over a 12-month period. The study group, which underwent debridement, contained 28 CVLU whose wound beds had slough, nonviable tissue, and no granulation tissue. The control group was 27 CVLU with minimal (15-20%) granulation tissue, but no slough or nonviable tissue. Treatments were otherwise similar. Age, body mass index, mean ulcer surface area (MSA) and mean ulcer duration were comparable in both groups. Ulcer measurements were taken at 4 weeks before debridement, at the time of debridement, and 4 and 20 weeks post-debridement. There was no change in the MSA from 4 weeks before to the time of debridement in either group. At 4 weeks post-debridement, the study ulcers showed a 6 cm(2) reduction in the MSA vs. a 1 cm(2) reduction in controls (P = 0.02). By week 20 post-debridement, the study ulcers achieved a 7.4 cm(2) reduction in the MSA vs. an increase of 1.3 cm(2) in controls (P = 0.008). Between weeks 8 and 20 post-debridement, 16% of study ulcers vs. 4.3% of control ulcers achieved complete healing. Infection rates and antimicrobial usage were similar. We conclude that sharp debridement is effective in stimulating healing of recalcitrant CVLU. It is safe, well tolerated, and can be performed in an outpatient setting.
authors.affiliation: Wound Healing Research Unit, University of Wales College of Medicine, Cardiff University, Cardiff, United Kingdom.
authors.forename: Dean
authors.initials: D
authors.lastname: Williams
authors.forename: Stuart
authors.initials: S
authors.lastname: Enoch
authors.forename: David
authors.initials: D
authors.lastname: Miller
authors.forename: Karen
authors.initials: K
authors.lastname: Harris
authors.forename: Patricia
authors.initials: P
authors.lastname: Price
authors.forename: Keith G
authors.initials: KG
authors.lastname: Harding
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D003475:Curettage / Q000379:methods; D003646:Debridement / Q000295:instrumentation*; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome; D014647:Varicose Ulcer / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D014945:Wound Healing