title: A systematic review and meta-analysis of débridement methods for chronic diabetic foot ulcers.
abstract: BACKGROUND
  Several methods of débridement of diabetic foot ulcers are currently used. The relative efficacy of these methods is not well established.
  
  
  METHODS
  This systematic review and meta-analysis was conducted to find the best available evidence for the effect of débridement on diabetic foot wound outcomes. We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus through October 2011 for randomized controlled studies (RCTs) and observational comparative studies.
  
  
  RESULTS
  We identified 11 RCTs and three nonrandomized studies reporting on 800 patients. The risk of bias was moderate overall. Meta-analysis of three RCTs showed that autolytic débridement significantly increased the healing rate (relative risk [RR], 1.89; 95% confidence interval [CI] 1.35-2.64). Meta-analysis of four studies (one RCT) showed that larval débridement reduced amputation (RR, 0.43; 95% CI, 0.21-0.88) but did not increase complete healing (RR, 1.27; 95% CI, 0.84-1.91). Surgical débridement was associated with shorter healing time compared with conventional wound care (one RCT). Insufficient evidence was found for comparisons between autolytic and larval débridement (one RCT), between ultrasound-guided and surgical débridement, and between hydrosurgical and surgical débridement.
  
  
  CONCLUSIONS
  The available literature supports the efficacy of several débridement methods, including surgical, autolytic, and larval débridement. Comparative effectiveness evidence between these methods and supportive evidence for other methods is of low quality due to methodologic limitations and imprecision. Hence, the choice of débridement method at the present time should be based on the available expertise, patient preferences, the clinical context and cost.
authors.affiliation: Evidence-based Practice Center, Mayo Clinic, Rochester, Minn.
authors.forename: Tarig
authors.initials: T
authors.lastname: Elraiyah
authors.affiliation: Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Domecq
authors.affiliation: Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Prutsky
authors.affiliation: Second Medical Department, Aristotle University, Thessaloniki, Greece.
authors.forename: Apostolos
authors.initials: A
authors.lastname: Tsapas
authors.affiliation: Evidence-based Practice Center, Mayo Clinic, Rochester, Minn.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Nabhan
authors.affiliation: Department of Podiatry, Phoenix VA Health Care System, Phoenix, Ariz.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Frykberg
authors.affiliation: Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Department of Internal Medicine, University of Missouri, Columbia, Mo.
authors.forename: Rim
authors.initials: R
authors.lastname: Hasan
authors.affiliation: Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Department of Internal Medicine, University of Missouri, Columbia, Mo.
authors.forename: Belal
authors.initials: B
authors.lastname: Firwana
authors.affiliation: Mayo Clinic Libraries, Mayo Clinic, Rochester, Minn.
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Prokop
authors.affiliation: Evidence-based Practice Center, Mayo Clinic, Rochester, Minn; Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, Minn. Electronic address: murad.mohammad@mayo.edu.
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Murad
mesh_terms: D000328:Adult; D000368:Aged; D003646:Debridement / Q000379:methods*; D017719:Diabetic Foot / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome