The Influence of Adequate Debridement on Healing of Diabetic Ulcers Treated with Placental Tissue

TIMERS framework for managing hard-to-heal wounds emphasizes the importance of managing devitalized tissue, biofilm/infection, moisture, wound edge, repair/regeneration, and social factors. To obtain the highest level of treatment success and ultimately reduce costs, regenerative/advanced wound therapy must be used as an adjunct to, and not in lieu of, these good wound care practices. Wound debridement is a vital element in the treatment of diabetic foot ulcers (DFUs), yet many wound care clinicians have received little hands-on standardized training in surgical debridement, and there is often wide variance in opinion among clinicians as to what constitutes adequate debridement.

Our purpose is to evaluate the incidence of adequate debridement on wounds treated with placental tissue allografts comprised of dehydrated human amnion/chorion membrane(dHACM, n=54) or dehydrated human umbilical cord (dHUC, n=101) and examine the influence of adequate debridement on rates of complete healing within 12 weeks. All patients were enrolled in randomized trials evaluating efficacy of dHACM or dHUC compared to standard wound care. Images taken pre- and post-debridement were examined at study completion by a group of three wound care specialists blinded to group assignment, study sites, and the treating clinician.

Adequate debridement was defined as the exposure of healthy tissue in the ulcer bed, with no significant, callous, devitalized tissue, epibole, or foreign material present in or around the wound. Adequate debridement occurred in 112/155 (72%) of the overall sample, 45/54 (83%) of dHACM-treated ulcers, and 67/101 (66%) of dHUC-treated ulcers. Complete healing occurred in 96/112 (86%) of adequately debrided ulcers and in only 13/43 (30%) of ulcers without adequate debridement, p<.0001.

Debridement remained a significant factor for healing even when controlling for other clinical characteristics. Adequate wound debridement is an essential component of wound care and influences rates of healing achieved with dHACM and dHUC allografts.