Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Palackic,A.
Non-surgical Debridement in Plastic Surgery: A Systematic Review
Humanmedizin; [Diplomarbeit] Medical University of Graz;2019. pp. 77
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Kamolz Lars-Peter
- Wurzer Paul
- Altmetrics:
- Abstract:
- Background: Many different non-surgical debridement methods are available for the treatment of chronic necrotic ulcers and burn wounds. So far, there is no existing systematic review describing these procedures in relation to each other for the field of plastic surgery. Hence, we conducted a systematic review to outline established therapy approaches and to see if there is evidence for the use of non-surgical debridement methods for chronic necrotic ulcers and burns. Methods: The review protocol was registered on PROSPERO (CRD42017057590). In October 2016, pre-defined MESH terms on non-surgical debridement methods were used to search the PubMed and Web of Science databases. Results were systematically exported to an Excel spreadsheets and duplicates removed. Non-suitable articles were excluded following defined exclusion criteria and then classified according to their Level of Evidence (LoE) I-V. Studies with a LoE I were included in the systematic review. Results: In total, 8042 articles could be identified using the pre-defined MESH-terms. After the systematic synthesis, 8 articles, which had an LOE I, were included in the final analysis. Three studies examined larval therapy and compared it to hydrogels. They showed that they enabled faster debridement than treatment with hydrogels; however, this treatment was associated with greater pain. A single study compared the larval therapy plus compression with compression without debridement. Here it could be shown, that the therapy with larvae achieved good results in regards to the speed of debridement. In none of these studies the therapy with larvae had a significantly more positive effect on wound healing. One study examined Clostridium Collagenase ointment (CCO) for the debridement of diabetic foot ulcers. In this study, all patients achieved a significant reduction in necrotic areas. In addition, enzymatic debridement with CCO had a positive effect on wound healing. One study investigated enzymatic debridement with NexoBrid (NXB) in burns, and showed that they could reduce the use of conventional surgical methods. Discussion: This systematic review demonstrates that there is a lack of evidence for non-surgical debridement methods in the treatment of necrotic sloughy ulcers and burns. Based on our results, larval debridement therapy seems to be faster than conventional methods using hydrogel. However, they don’t improve wound healing, so they might be used for more acute complex wounds. More randomized trials are needed in order to confirm these results. NXB, an enzymatic selective debriding agent, seems to be a good alternative approach for deep and full thickness burns. Results showed that there is less debridement dependent blood loss, less scars and reduced need for surgical interventions in comparison with conventional methods.