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Management of Skin Ulcers: Understanding the Mechanism and Selection of Enzymatic Debriding Agents

Wound care practitioners are responsible for achieving certain evidence-based therapeutic objectives during the course of treatment for skin wounds. Among these goals are maintaining a moist wound environment, offloading pressure and shear, protecting against infection, identifying or establishing arterial supply, and removing nonviable tissue. Wound debridement removes nonviable tissue and protects against developing critical bacterial colonization. It also eliminates closed wound spaces that harbor bacteria. Thus, debridement is a critical factor in enhancing wound healing. In a multicenter, retrospective analysis, it was found that using platelet-derived growth factor in the management of diabetic wounds and higher frequency of debridement demonstrated increased healing rates. Although there is much agreement that sharp debridement is essential to the management of the wound when indicated, less attention was focused on the potential that enzymatic debridement has in the removal of nonviable tissue from the wound, despite its common use by wound care specialists. Enzymatic debridement is defined as the use of topically applied chemical agents to facilitate the breakdown of necrotic or other nonviable tissue in the wound. Two types of enzymatic agents are available on the market todayVpapain-urea agents and collagenase.