Wounds Heal Better When Frequently Debrided

Most wounds were diabetic foot ulcers (DFU, 19%), venous leg ulcers (VLU, 26.1%), and pressure ulcers (PU, 16.2%). The intervention involved debridement at different frequencies, with the main outcome and measure being wound healing, defined as complete epithelialization.

The results showed that 70.8% of wounds were recorded as having healed. The highest rate of healing occurred in traumatic wounds at 78.4%, and the lowest rate was found among PU at 56.6%. The median number of debridements was two across the sample, but varied considerably among different wound types. For DFUs, median time to heal after weekly or more frequent debridement was 21 days. When debridement frequency was slowed to every 1–2 weeks, healing time increased to 64 days, and when wounds were debrided no more than once every 2 weeks, healing time increased to 76 days.

For traumatic wounds, the median time to heal after weekly or more frequent debridement was 14 days. Debridement every 1–2 weeks increased the healing time to 42 days, and to 49 days for debridement every 2 weeks or more. Nearly twice as many VLUs and DFUs healed completely with frequent debridement compared with those treated less frequently, 50% versus 28% for VLUs and 30% versus 13% for DFUs, respectively. The study was published early online on July 24, 2013, in JAMA Dermatology.

“The more frequent the debridements, the better the healing outcome,” concluded lead author Scott Covington, MD, of and colleagues. “Higher frequency debridement improved healing outcomes with shorter healing times, while longer intervals between debridement of wounds were associated with longer treatment times and slower healing. These results were consistent with those found in previous studies.”

Debridement is the key process of wound bed preparation, defined as the removal of dead necrotic tissue, bacteria, and other foreign bodies from the wound. When a wound is debrided, platelets occupy the wound space to begin clotting, initiating the first, inflammatory phase of wound healing. In the first 48 hours, healing is managed by platelet-derived and transforming growth factors (GFs). Once circulating monocytes become tissue macrophages, they supply key multiple GFs for healing. A long-term wound usually is trapped in the inflammatory phase, but aggressive debridement can transform it once again into an acute wound, and therefore complete healing.


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