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Original Investigation |

Frequency of Debridements and Time to Heal:  A Retrospective Cohort Study of 312 744 Wounds

James R. Wilcox, RN1; Marissa J. Carter, PhD, MA2; Scott Covington, MD1
[+] Author Affiliations
1Healogics, Jacksonville, Florida
2Strategic Solutions Inc, Cody, Wyoming
JAMA Dermatol. 2013;149(9):1050-1058. doi:10.1001/jamadermatol.2013.4960.
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Importance  Chronic wounds usually get trapped in the inflammatory stage of wound healing; however, aggressive debridement transforms chronic wounds to acute wounds and therefore complete healing.

Objective  To investigate healing outcomes and debridement frequency in a large wound data set.

Design  Retrospective cohort study.

Setting  Data collected from 525 wound care centers from June 1, 2008, through June 31, 2012, using a web-based clinical management system.

Patients  Referred sample of 154 644 patients with 312 744 wounds of all causes (of an initial data set of 364 534 wounds) participated. A total of 47.1% were male. Median age was 69 years (age range, 19-112 years), with 59.2% having one wound. Eligibility criteria included age older than 18 years, receiving at least 1 debridement, and having been discharged from the system. Advanced therapeutic treatment was ineligible. Because of incomplete, questionable, or ineligible data, 57 190 wounds were not included. Most wounds were diabetic foot ulcers (19.0%), venous leg ulcers (26.1%), and pressure ulcers (16.2%).

Intervention  Debridement (removal of necrotic tissue and foreign bodies from the wound) at different frequencies.

Main Outcome and Measure  Wound healing (completely epithelialized with dimensions at 0 × 0 × 0 cm).

Results  A total of 70.8% of wounds healed. The median number of debridements was 2 (range, 1-138). Frequent debridement healed more wounds in a shorter time (P <  .001). In regression analysis, significant variables included male sex, physician category, wound type, increased patient age, and increased wound age, area, and depth. The odds ratio varied considerably for each variable.

Conclusions and Relevance  The more frequent the debridements, the better the healing outcome. Although limited by retrospective data, this study’s strength was the analysis of the largest wound data set to date.

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debridement

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Figures

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Figure 1.
Categories of Wound Causes Used in the Analysis
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Figure 2.
Healing Rates for the Different Categories of Wounds
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Figure 3.
Percentage of Debridements by Interval Between Debridements According to Wound Category

For each wound category, the sum of the different debridement frequencies is 100%.

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Figure 4.
Association Between Percentages of Healed Wounds and Time to Heal

Wounds with debridement intervals of 1 week or less healed significantly faster.

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Figure 5.
Kaplan-Meier Plot of Diabetic Foot Ulcers Showing That Shorter Intervals Between Debridement Improve Time to Heal
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Figure 6.
Kaplan-Meier Plot After Adjustment for All Confounding Variables Showing That Shorter Intervals Between Debridement Improve Time to Heal
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