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Olga Perifanou, Martha Kelesi, Maria Polikandrioti, Georgios Vasilopoulos

Friday, July 1, 2022

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Pages: 288-303

DOI: 10.5281/zenodo.7771487


Introduction: Debridement is a critical procedure that can accelerate wound healing. One technique used in clinical practice to achieve debridement is enzymatic debridement, which is effective for all types of wounds.. Aim: This systematic review aims to investigate the efficacy of enzymatic debridement in the healing process of diabetic foot ulcers. A literature search was conducted using Pubmed and Cochrane databases from 2016 to 2021, using the keywords "enzymatic debridement" and "diabetic ulcer" in the Title, Abstract, Keywords or in all possible combinations used in the various articles.Initially, 30 studies were identified, and after applying inclusion and exclusion criteria, five clinical trials were included in the review. Of the five studies, three were multicentre randomised trials, and two were comparative prospective studies. Three studies compared the application of different forms of collagenase with other debridement methods (autolytic debridement using hydrogel, sharp debridement, mechanical debridement) for the removal of tissue necrosis. Two studies examined the effectiveness of bromelain. All studies focused on chronic wounds and ulcers, including diabetic foot ulcers.The results of the studies showed that the use of enzymatic debridement is an effective and safe method that achieves comparable results in terms of reduction of ulcer area, faster closure, and reduction of pain compared to other methods, while retaining the advantage of being non-invasive. However, more randomized controlled trials with larger sample sizes are required to further investigate the effectiveness and safety of the method, as some studies had insufficient samples or non-standardized treatment during the follow-up period, which may have influenced the results. Additionally, many studies used specific commercial formulations.In conclusion, this systematic review provides evidence that enzymatic debridement is an effective and safe method for the management of diabetic foot ulcers. However, further research is needed to better understand its efficacy and safety. The findings of this review should be considered in conjunction with individual patient factors and clinical judgement when making treatment decisions.

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