Letter to the Editor

Dr. Bolton,

I appreciate each Evidence Corner you provide to us readers.

I read with interest the recent journal¹ and the [review about] sharp debridement and collagenase on diabetic foot ulcers. I had a difficult time understanding that all the wounds were partial-thickness not extending below the dermis, however there was a requirement for debridement evidently of devitalized tissue.

My experience over 30 years in wound care is that in partial-thickness wounds, any debris is limited to dried or moist epidermis. Most, if not all, of this type of wound is cared for by a local moist wound environment. Of course overall one must consider comorbidities to optimize any outcome.

Am I missing something?

Appreciate your time and response.

Denise Elber, RN, CWOCN
Wound, Ostomy, Continence Specialist
University Hospitals Parma Medical Center
Parma, OH

Dear Ms. Elber,

Thank you for your interesting comment questioning the need to use serial debridement with or without collagenase to remove devitalized tissue from the surface of partial-thickness diabetic foot ulcers as described by Motley et al² and reviewed in the August Evidence Corner.¹

You make a valid point that autolytic debridement using hydrogels¹ or hydrocolloid dressings³ to maintain a moist wound environment improves diabetic foot ulcer healing² and is associated with lower likelihood of diabetic foot ulcer infection⁴ compared to gauze use.

To the best of my knowledge, such compelling evidence is still needed to support serial sharp debridement efficacy for improving diabetic foot ulcer healing and/or infection rates compared to gauze or compared to more effective autolytic debridement.

Laura Bolton, PhD
Adjunct Associate Professor
Department of Surgery
Rutgers Robert Wood Johnson Medical School
New Brunswick, NJ