Clinic-based Debridement of Chronic Ulcers Has Minimal Impact on Bacteria

Outpatient-based sharp debridement is considered an important element for the care of a chronic ulcer.

The aim of this study is to evaluate the change in bacterial amounts with sharp debridement in a clinical setting.

Bacterial autofluorescence, quantitative cultures, semiquantitative cultures, and qualitative speciation were performed predebridement and postdebridement during a single clinic visit.

Thirty-six wounds were included in the analysis. The mean patient age was 62 years (range, 27-83 years), and there were 13 (36.11%) women and 23 (63.89%) men with an average body mass index of 33.8 kg/m² (range, 16.7-55.9 kg/m²). Of the 36 patients, 24 (66.67%) had type 2 diabetes and 19 (52.78%) had a prior history of lower extremity amputation. Majority of the ulcers were diabetic neuropathic (27, 75%); the most common location was on the plantar aspect of the foot (14, 41.67%) with a mean ulcer duration of 10 months (range, 1-36), mean ulcer area of 6.3 ± 12.8 cm² (range, 0.18-62.06 cm²), and mean volume of 2.2 ± 4.4 cm³ (range, 0.05-9.66 cm³). There was no statistically significant difference in bacterial autofluorescence between the predebridement (4.15 ± 8.82) and the postdebridement (4.65 ± 9.48) images (P = .32). There was a statistically significant difference in quantitative culture results between the predebridement (6.7 x 104 ± 1.4 x 106 CFU/cm²) and the postdebridement (1.7 x 104 ± 3.1 x 106 CFU/cm²) cultures (P = .04), although this is not a log reduction.

There is no statistically significant difference between the predebridement versus postdebridement semiquantitative culture results or a detectable pattern of change for the most common bacterial species encountered. These results suggest little impact of clinic-based sharp debridement on bacteria.