title: Debridement for surgical wounds.
abstract: 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.
  
  
  OBJECTIVE
  The aim of this review is to determine the effect of different methods of debridement on the rate of debridement and healing of surgical wounds.
  
  
  METHODS
  We developed a search strategy to search the following electronic databases: Wounds Group Specialised Trials Register (searched 3/3/08) , Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2008, issue 1), MEDLINE (1950 to February Week 3 2008 ), EMBASE (1980 to 2008 Week 09) and CINHAL (1982 to February Week 4 2008). We checked the citations within obtained studies to identify additional papers and also relevant conference proceedings. We contacted manufactures of wound debridement agents to ascertain the existence of published, unpublished and ongoing trials. Our search was not limited by language or publication status.
  
  
  METHODS
  We included relevant randomised controlled trials (RCT) with outcomes including at least one of the following: time to complete debridement, or time to complete healing.
  
  
  METHODS
  Two authors independently reviewed the abstracts and titles obtained from the search, two extracted data independently using a standardised extraction sheet, and two independently assessed methodological quality. One author was involved in all stages of the data collection and extraction process, thus ensuring continuity.
  
  
  RESULTS
  Five RCTs 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 and reported the time to complete debridement. Four of the 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.
  
  
  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.
authors.affiliation: School of Nursing, Midwifery and Social Care, Napier University, Canaan Lane Campus, Edinburgh, UK, EH9 2TB. n.dryburgh@napier.ac.uk
authors.forename: Nancy
authors.initials: N
authors.lastname: Dryburgh
authors.forename: Fiona
authors.initials: F
authors.lastname: Smith
authors.forename: Jayne
authors.initials: J
authors.lastname: Donaldson
authors.forename: Melloney
authors.initials: M
authors.lastname: Mitchell
mesh_terms: D003646:Debridement / Q000379:methods*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013530:Surgical Wound Infection / Q000601:surgery*; D014945:Wound Healing