Er:YAG Laser versus Sharp Debridement in Management of Chronic Wounds: Effects on Pain and Bacterial Load

Er:YAG Laser versus Sharp Debridement in Management of Chronic Wounds: Effects on Pain and Bacterial Load:

Abstract

Chronic wounds affect roughly 6.5 million patients in the United States annually. Current standard of therapy entails weekly sharp debridement. However, the sharp technique is associated with significant pain, while having minimal impact on the bioburden. Our study proposes the Er:YAG laser as an alternative method of debridement that may decrease procedural pain, reduce bioburden, and potentially improve overall healing. This pilot study was performed as a prospective, randomized, controlled, crossover clinical trial, containing two groups: 1) one group underwent single laser debridement session first, followed by single sharp debridement session one week later; 2) the other group underwent single sharp debridement session first, followed by single laser debridement session one week later. Variables analyzed included pain during debridement, pre‐ and post‐debridement wound sizes, pre‐ and post‐debridement bacterial loads and patient preference. Twenty‐two patients were enrolled (12 patients in Group 1, plus 10 patients in Group 2). The mean pain score for patients undergoing laser debridement was 3.0 ± 1.7 versus 4.8 ± 2.6 for those undergoing sharp debridement (p = 0.003). The mean percent change in wound size one‐week post‐laser debridement was ‐20.8% ± 80.1%, as compared with ‐36.7% ± 54.3% one‐week post‐sharp debridement (p = 0.6). The percentage of patients who had a bacterial load in the Low/Negative category increased from 27.3% to 59.1% immediately after laser debridement (p = 0.04), versus 54.5% to 68.2% immediately after sharp debridement (p = 0.38). Moreover, there was a sustained decrease in bacterial load one‐week post‐laser debridement, as compared with no sustained decrease one‐week post‐sharp debridement (p < 0.02). Overall, 52.9% of patients preferred laser debridement versus 35.3% for sharp debridement. We believe that Er:YAG laser serves as a promising technology in chronic wounds, functioning as a potentially superior alternative to sharp debridement, the current standard of therapy.

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