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Copyright ©The Author(s) 2015.
World J Diabetes. Feb 15, 2015; 6(1): 37-53
Published online Feb 15, 2015. doi: 10.4239/wjd.v6.i1.37
Table 1 Different kind of debridement for patients with diabetic foot ulcer
Surgical or SharpCallus and all nonviable soft tissues and bone remove from the open wound with a scalpel, tissue nippers, curettes, and curved scissors. Excision of necrotic tissues should extend as deeply and proximally as necessary until healthy, bleeding soft tissues and bone are encountered[59]Only requires sterile scissors or a scalpel, so is cost-effective[55]Requires a certain amount of skill to prevent enlarging the wound[55]
MechanicalThis method includes wet to dry dressings, high pressure irrigation, pulsed lavage and hydrotherapy[76], and commonly used to clean wounds prior to surgical or sharp debridement[76]Allows removal of hardened necrosisIt is not discriminating and may remove granulating tissue It may be painful for the patients[55]
AutolyticThis method occurs naturally in a healthy, moist wound environment when arterial perfusion and venous drainage are maintained[18]It’s cost-effective[55] It is suitable for an extremely painful wound[18]It’s time consuming and may require an equivocal time for treatment[18]
EnzymaticThe only formulation available in the United Kingdom contains Streptokinase and Streptodornase (Varidase Topical® Wyeth Laboratories). This enzyme aggressively digests the proteins fibrin, collagen and elastin, which are commonly found in the necrotic exudate of a wound[77,78]They can be applied directly into the necrotic area[55]Streptokinase can be systemically absorbed and is therefore contraindicated in patients at risk of an MI It’s expensive[55]
BiologicalSterile maggots of the green bottle fly (Lucilia sericata) are placed directly into the affected area and held in place by a close net dressing. The larvae have a ferocious appetite for necrotic material while actively avoiding newly formed healthy tissue[79,80]They discriminate between the necrotic and the granulating tissue[79]There may be a reluctance to use this treatment by patients and clinicians It’s expensive[79,80]