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Regular wound cleaning tied to faster healing

By Genevra Pittman

NEW YORK (Reuters Health) - Chronic wounds such as diabetic foot ulcers and pressure ulcers may heal faster when they are cleaned out frequently, a new study suggests.

So-called debridement involves removing dead or infected tissue and any foreign bodies or bacteria from slow-healing wounds, such as with a scalpel or special cream.

It's traditionally performed when a patient first comes in with a wound, said Dr. Robert Kirsner, a dermatologist and wound researcher from the University of Miami Miller School of Medicine.

"The real question is, how often do you have to do this?" added Kirsner, who co-wrote a commentary published with the new study.

Close to seven million Americans each year have a chronic wound, from diabetes or other causes.

A few small studies have suggested some types of wounds tend to heal faster with frequent cleaning.

For their report, James Wilcox from Healogics - a company that runs wound care centers - and his colleagues tried to expand on those data by reviewing the records of about 155,000 patients treated at one of 525 wound centers.

Between 2008 and 2012, those patients were treated for a total of 313,000 wounds, including diabetic foot and pressure ulcers, surgical wounds and cuts from accidents or other trauma. The average wound was cleaned out twice.

The researchers found that healing time varied by the type of wound, but was typically faster with more frequent debridement.

For example, diabetic foot ulcers healed in an average of 21 days when they were debrided at least weekly and in 76 days, on average, when they were debrided once every two weeks or more. Traumatic wounds healed in 14 days, on average, with frequent debridement and in 49 days when they were cleaned out least often.

Healing time was also longer for deeper and wider wounds, the research team wrote in JAMA Dermatology.

Bacteria can grow over wounds in colonies called biofilms, Kirsner said. Much like brushing your teeth prevents biofilms from growing on them, debridement may keep wounds free of bacterial colonies, he added.

But debridement isn't quite as easy and innocuous as teeth brushing.

"There's effort in doing it - there's effort as far as cost and in theory there could be pain associated with it," Kirsner told Reuters Health.

"When you perform a surgical procedure, there's always the risk of infection. You wouldn't want to do debridements if they weren't necessary."

He said patients in the study who had their wounds cleaned out more frequently may have also been better at sticking to other care recommendations - so it's not clear the faster healing time was due solely to extra debridement.

Or, "It's possible that if you went to a specialized wound center every week and got a lot of treatments including debridement, that debridement may not have been the only critical thing that was done during that treatment."

Still, Kirsner said, the evidence is pointing toward a benefit from more frequent cleaning. And having slow-healing wounds regularly evaluated is important, he added, to make sure they continue to improve.

Especially among people with diabetes and loss of sensation in the feet, non-healing wounds can become gangrenous and force amputation.

SOURCES: http://bit.ly/13L1Ze9 and http://bit.ly/1bqsJWS JAMA Dermatology, online July 24, 2013.

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