Department of Dermatology, Centro Hospitalar Lisboa Central, Hospital Santo António dos Capuchos, Lisbon, Portugal.
Int Wound J. 2018 Jun;15(3):438-440. doi: 10.1111/iwj.12884. Epub 2018 Jan 15.
Debridement is essential for the optimal care of venous leg ulcers. Several debridement methods with different limitations may be deployed. Trichloroacetic acid (TCA) is used for several dermatological purposes. Its application as a chemical debridement method for leg ulcers has never been explored. We designed a prospective study to determine the role of 80% TCA solution as a chemical debridement method for leg ulcers, regarding efficacy and procedure-associated pain. Chronic venous leg ulcers were treated with 3 cycles of 80% TCA solution or curettage over 1 week. Pain and the mean percentage of fibrin and devitalized tissue covering wound bed were evaluated. At the end of the study, a trend towards larger fibrin mean reduction among the TCA treated ulcers was observed, although this difference was not statistically significant (P = .35). The mean pain score after TCA application was significantly reduced compared to pain after curettage alone (P < 0.001). TCA presented several advantages over mechanical debridement: it is a more selective debridement method, has haemostatic properties, and a simpler and faster application. The 80% TCA solution may be a cheap, simple, and considerably less-painful chemical debridement method for venous leg ulcers compared to classical mechanical debridement.
清创术对于静脉性腿部溃疡的最佳治疗至关重要。可以使用多种具有不同局限性的清创方法。三氯乙酸(TCA)用于多种皮肤病学用途。从未探索过将其作为腿部溃疡的化学清创方法。我们设计了一项前瞻性研究,以确定 80%TCA 溶液作为腿部溃疡的化学清创方法的作用,包括疗效和与操作相关的疼痛。慢性静脉性腿部溃疡在 1 周内接受 3 个周期的 80%TCA 溶液或刮除术治疗。评估疼痛和覆盖伤口床的纤维蛋白和失活组织的平均百分比。在研究结束时,尽管差异无统计学意义(P=.35),但 TCA 治疗的溃疡中纤维蛋白的平均减少趋势更大。与单独刮除术相比,TCA 应用后的平均疼痛评分明显降低(P<0.001)。TCA 相对于机械清创具有几个优势:它是一种更具选择性的清创方法,具有止血作用,并且应用更简单、更快。与传统的机械清创相比,80%TCA 溶液可能是一种廉价、简单且疼痛明显减轻的治疗静脉性腿部溃疡的化学清创方法。