Comparative Efficacy of Autolytic and Collagenase-Based Enzymatic Debridement in Chronic Wound Healing: A Comprehensive Systematic Review

Abstract

Chronic wounds, including diabetic foot ulcers, pressure ulcers, and burn injuries, present significant challenges for healthcare systems, with debridement being crucial for healing. This review compares the efficacy of autolytic and enzymatic debridement techniques. The objective was to assess clinical outcomes related to both methods, focusing on wound size reduction, granulation tissue formation, epithelialisation, complete healing, and adverse events. A systematic review of randomised controlled trials (RCTs) was performed across multiple databases, identifying five eligible studies involving 236 patients. Results indicated that enzymatic debridement was more effective, showing faster wound size reduction in four out of five studies, with Baloorkar et al. reporting a 65% size reduction compared to 50% for autolytic debridement (p < 0.05). Granulation tissue formation and epithelialisation rates were also significantly higher with enzymatic methods. Complete healing occurred in 65% of cases using enzymatic debridement versus 50% for autolytic methods (p = 0.04). Mild irritation was the most common adverse event noted in the enzymatic group. In conclusion, enzymatic debridement proved to be superior for severe wounds, while autolytic debridement remains beneficial for less severe cases due to its non-invasive nature. Both methods were well tolerated, but further research is needed for definitive clinical guidelines.