Wunddebridement des Ulcus cruris et pedis: Einfluss auf die Heilung und die Effektivität verschiedener Methoden

Abstract

To evaluate the evidence on the impact of different debridement techniques on healing and their efficacy in the treatment of leg ulcers. Methods: Web-based search (PubMed) for trials investigating surgical, enzymatic, autolytic, osmotic, ultrasound-assisted, and biosurgical wound debridement on leg ulcers with regard to healing and efficacy. Results: Both surgical and hydrosurgical methods proved to be effective debridement techniques. For conventional surgical debridement, a significantly greater reduction of the wound surface area and a higher healing rate were reported. Studies on autolytic, osmotic, and enzymatic wound debridement showed effective debridement for krill enzymes, dextranomer and manuka honey. Only for manuka honey was there a significantly greater reduction of the wound surface area compared to standard treatment. One study comparing fibrinolysin/DNAse with placebo and one comparing autolytic with enzymatic debridement showed no significant differences between the respective techniques. Trials on ultrasound-assisted wound debridement reported a positive impact on healing. A significant wound surface area reduction was demonstrated in one of them. Maggot therapy led to effective debridement. The largest trial showed no significantly improved healing. Conclusions: Further studies are needed to strengthen the evidence for a significant impact of wound debridement on the healing of leg ulcers. © Blackwell Verlag GmbH, Berlin.