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Invited Commentary | Practice Gaps

Frequent Debridement for Healing of Chronic Wounds

Elizabeth Lebrun, MD1; Robert S. Kirsner, MD, PhD1
[+] Author Affiliations
1Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
JAMA Dermatol. 2013;149(9):1059. doi:10.1001/jamadermatol.2013.4959.
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Chronic wounds, such as from diabetes and vascular disease, affect almost 7 million Americans annually, cost nearly $25 billion annually, and are associated with increased mortality.1 Standard care for the treatment of chronic wounds includes debridement, with best evidence existing for diabetic foot ulcers, where secondary analysis of randomized trials suggests centers with higher frequency of debridement have superior healing rates.2 The rationale for debridement is to remove tissue and debris that inhibit healing, which at times is obvious, for example, when necrotic eschar or excessive callus is present, but at other times is less obvious, for example, when trying to remove bacterial biofilms or abnormal host cells that may also contribute to slow healing. For example, keratinocytes adjacent to chronic wounds have a diminished ability to migrate and respond to growth factors and contribute to a pathogenic phenotype that inhibits healing.2

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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