What is the Ideal Quality and Frequency of DFU Debridement?

Tettlebach and coworkers have more compelling data supporting debridement in a recent study.¹ The team set out to evaluate debridement’s impact when using placental-derived allografts for diabetic foot ulcers (DFUs) and looked at data from 2 prospective, multicenter, randomized controlled trials. They then compared this data with a retrospective analysis of 5 years of Medicare DFU claims.
 
The authors found that quality of debridement and frequency of debridement matters. Debridement was the most significant contributor to wound closure, and also positively impacted major amputation, ER visits, and resource usage. Specifically, they found no more than 7-day intervals between debridements to be ideal.
 
As far as quality debridement goes, we recently collectively authored a manuscript that shares the operations definition thereof.² There is likely not a magic number, in my experience, when it comes to frequency of and intervals between debridement; but rather, there is a number that is best for each individual patient. Some may be able to return for debridement every other week or even longer, but, it appears that on the aggregate, 7 days came out as a good cut point in this study. We believe that patients likely require 1 really good quality debridement and subsequent good quality “maintenance debridements” that might help move the patient toward healing and into diabetic foot remission.
 
Dr. Armstrong is Professor of Surgery at the Keck School of Medicine at the University of Southern California. He is the Director of the Southwestern Academic Limb Salvage Alliance (SALSA).
 
Reference
1.     Tettlebach WH, Cazzell SM, Hubbs B, De Jong JL, Forsyth RA, Reyzelman AM. The influence of adequate debridement and placental-derived allografts on diabetic foot ulcers. J Wound Care. 2022;31(Sup9):S16-S26.
2.     Eriksson E, Liu PY, Schultz, GS, et al. Chronic wounds: treatment consensus. Wound Repair Regen. 2022;30(2):156-171.

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