Network meta-analysis ranks debridement strategies for venous and diabetic ulcers

This study aimed to compare debridement strategies for chronic lower-extremity wounds using a systematic review and Bayesian network meta-analysis. This study followed the PRISMA-NMA guidelines. PubMed, Embase, Web of Science, the Cochrane Library, CNKI, Wanfang, and VIP were searched from January 1990 to February 2026. Randomized controlled trials involving venous leg ulcers, arterial or ischemic ulcers, mixed arterial–venous ulcers, or diabetic foot ulcers were included. The outcomes included wound healing, complete debridement, pain score, procedure time, and time to healing. Pairwise meta-analysis and Bayesian network meta-analysis were performed. Surface under the cumulative ranking curve (SUCRA) rankings were interpreted according to the clinical direction of each outcome. A total of 25 randomized controlled trials were included. For wound healing, biological debridement (BIO) had the highest ranking probability (SUCRA = 99.5%), followed by enzymatic debridement (ENZ) (83.1%) and mechanical debridement (MECH) (65.9%). For complete debridement, biological debridement ranked first (95.7%), followed by enzymatic debridement (70.9%), autolytic debridement (AUTO) (32.2%), and standard care (SC) (1.2%). For pain score, procedure time, and time to healing, lower values represented better outcomes; rankings for these endpoints were therefore interpreted in that direction. Enzymatic and autolytic debridement ranked more favorably for pain score, biological and ultrasound-assisted debridement (US) for procedure time, and biological and autolytic debridement for time to healing. Several comparisons had wide credible intervals, and certainty of evidence was limited by clinical heterogeneity, sparse networks, and methodological limitations. The comparative profile of debridement strategies varied by the outcome. Biological and enzymatic debridement ranked favorably for wound healing and complete debridement, whereas enzymatic and autolytic debridement were associated with lower pain scores. Ultrasound-assisted debridement may be more efficient in terms of procedure time. These findings should be interpreted cautiously because ranking probabilities do not establish clinically decisive superiority, especially when evidence is sparse or heterogeneous. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420261341535.