Typically, a chronic wound, such as a diabetic foot ulcer, a venous leg ulcer, a sore caused by poor circulation, or a bedsore, can take weeks or even months to heal. The longer it takes, the greater your risk of serious, potentially life-threatening complications.
Research shows that healing time can be dramatically reduced—not by a new drug or treatment, but by how frequently a procedure called debridement is done.
Types of wound debridement
Debridement is the removal of dead, or necrotic, tissue and debris that can inhibit healing.
Your doctor has multiple options for debriding a wound, depending on its type. Some kinds of debridement may be combined. Types of debridement include:
• Surgical debridement. This involves cutting away dead tissue with a scalpel or scissors. Surgical debridement is most often used when large areas of tissue must be removed and infection is present.
• Mechanical debridement. One form of mechanical debridement involves allowing a moist dressing applied to the skin to dry overnight. The dressing is then pulled off, taking the dead skin with it. Other types of mechanical debridement use a whirlpool bath or a pressurized irrigation device.
• Enzymatic debridement. Enzymes and chemical dressings are applied to the wound to dissolve dead tissue and debris. Once chemicals are applied to the skin, a moist dressing is placed over the wound.
• Autolytic debridement. This type of debridement depends on the body’s own ability to dissolve dead tissue. A dressing is applied to the wound to keep the skin moist while enzymes naturally present in the wound digest dead tissue.
Guidelines from the Wound Healing Society call for ongoing debridement while a wound heals. The key to speeding up healing, according to research published online in 2013 by JAMA Dermatology, is how often the procedure is done.
Faster healing times
Researchers analyzed the treatment of more than 312,000 wounds in adults (median age, 69). They found that foot ulcers debrided weekly or more often took roughly 21 days to heal. The same kind of wound took 64 days to heal when debrided every one to two weeks and 76 days if the time between debriding was two weeks or more.
That means wounds treated with weekly debridement healed three to four times faster than wounds debrided less frequently.
Not for everyone
Debridement isn’t for all patients. In particular, patients with peripheral arterial disease (PAD) can’t safely undergo the procedure because it can worsen wounds. PAD is caused by a narrowing of the arteries that deliver blood to the extremities, usually the legs.
Vascular studies are typically performed before initiating debridement to determine the degree of arterial (and venous) disease. If significant arterial disease is found, your doctor may consider revascularization by a vascular surgeon. Revascularization, which includes bypass surgery and angioplasty, can improve blood flow. Similarly, swelling associated with venous disease also hinders wound healing.
Several compression techniques can be used safely in the absence of arterial disease, including:
• Layered compression wraps
• Compression stockings
• Pneumatic compression pumps, which are medical devices that can improve
• Surgical correction of the venous disease
All have a proven benefit in healing wounds.
In addition, if you’re diabetic, controlling your blood sugars will also help promote wound healing. Finally, cessation of smoking is of paramount importance, as smoking prevents healing of all wounds.
Don’t put off appointments
The JAMA Dermatology study illustrates the importance of closely adhering to your treatment plan when dealing with chronic wounds.
Getting to the doctor frequently can be challenging, but by avoiding appointments you may be prolonging the length of time you have to live with the wound, as well as exposing yourself to the possibility of a serious infection.
If you’re a candidate for debridement and your doctor suggests scheduling the procedure less often than once a week, ask why. Discussing it will help ensure you get the best possible treatment.
The study was partially sponsored by Healogics, a for-profit company that specializes in wound treatment, and several of the researchers were employed by the company. Nevertheless, the findings are consistent with earlier research focused on the effectiveness of debridement.
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