From the Guidelines
Chemical debridement agents should not be used over standard of care, which includes sharp debridement and basic wound dressings, according to the most recent guidelines 1. When considering the use of chemical debridement agents in wound care, it is essential to prioritize the most recent and highest quality evidence. The 2023 update of the International Working Group on the Diabetic Foot (IWGDF) guidelines 1 provides strong recommendations against the use of chemical debridement over standard of care. Some key points to consider when evaluating the use of chemical debridement agents include:
- The IWGDF guidelines recommend against the use of autolytic, biosurgical, hydrosurgical, chemical, or laser debridement over standard of care 1.
- Sharp debridement is recommended as the standard of care, with the frequency determined by the clinician based on clinical need 1.
- Enzymatic debridement may be considered in specific situations where sharp debridement is not available due to limited resources or skilled personnel 1. It is crucial to weigh the potential benefits of chemical debridement agents against the current evidence and guidelines, which prioritize standard of care, including sharp debridement and basic wound dressings 1.
From the FDA Drug Label
Collagenase Santyl◊ Ointment should be applied once daily (or more frequently if the dressing becomes soiled, as from incontinence). Use Collagenase Santyl◊ Ointment in the following manner: Use of Collagenase Santyl◊ Ointment should be terminated when debridement of necrotic tissue is complete and granulation tissue is well established.
Chemical debridement agents, such as collagenase, are used in wound care to debride necrotic tissue and promote granulation tissue. The specific agent, Collagenase Santyl◊ Ointment, is applied once daily to the wound, and its use is terminated when debridement is complete and granulation tissue is well established 2. Key points for use include:
- Applying the ointment directly to the wound or to a sterile gauze pad
- Cleansing the wound of debris and digested material before application
- Using an appropriate topical antibiotic powder when infection is present
- Terminating use when debridement of necrotic tissue is complete and granulation tissue is well established.
From the Research
Chemical Debridement Agents in Wound Care
Chemical debridement agents are used in wound care to rapidly disrupt biofilms, reduce bacterial load, and facilitate healing with fewer side effects or procedural discomfort.
- The selection of the most appropriate debridement method depends on many factors such as tissue type, presence of biofilm, depth and location of the wound, underlying cause, skills of the person performing the debridement, and the preferences of the patient 3.
- Debridement is one component of the concept of wound bed preparation that has long guided the approach to wound management, and the ability of a wound to heal must be determined prior to the initiation of any method of debridement 4.
- Enzymatic debridement with collagenase is a technique that is commonly used in clinical practice, and results support the use of collagenase for enzymatic debridement in pressure ulcers, diabetic foot ulcers, and in conjunction with topical antibiotics for burns 5.
Indications for Chemical Debridement Agents
Chemical debridement agents are used in various types of wounds, including:
- Chronic wounds, such as decubitus, vascular, inflammatory, and rheumatologic subtypes 6.
- Lower extremity wounds, including arterial, diabetic, pressure, and venous ulcers 7.
- Wounds with biofilm, as chemical debridement agents can help disrupt biofilms and reduce bacterial load.
Considerations for Using Chemical Debridement Agents
When using chemical debridement agents, it is essential to consider the following: