***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE A r and omised clinical trial ( n = 42 ) compared the effectiveness of two approaches to debriding chronic leg ulcers :  TenderWet 24 , which is design ed to support the autolytic degradation process , and Iruxol N ( Santyl ) , an enzymatic treatment cl aim ed to enhance the degradation process . METHOD Patients were r and omly assigned to one of the two treatment groups for three weeks . Wounds were evaluated weekly for the amount of eschar/slough , the area of healthy granulation and the re-epithelialised area . RESULTS During days 1 - 14 slough within the groups was reduced by almost 19 % for TenderWet 24 and by 9 % for Iruxol N , followed by an increase of 26 % and 10 % respectively in granulation tissue . These effects were less accentuated during days 7 - 21 . There was a further 11 % improvement in tissue debridement for the TenderWet 24 group and a relapse ( + 9.1 % ) in the Iruxol N group . CONCLUSION Although TenderWet 24 appeared to be more efficient in a few cases , the general efficacy of the two products appeared to be almost the same as no statistically significant superiority of either product was found BACKGROUND proteolytic enzymes such as collagenase , fibrinolysin and deoxyribonuclease are used for debriding purulent or fibrinous pressure ulcers . OBJECTIVE to test the hypothesis that collagenase debrides necrotic pressure ulcers more effectively than fibrinolysin/deoxyribonuclease . METHODS we enrolled 135 elderly patients with pressure ulcers in a r and omized , prospect i ve double-blind trial . Patients were treated until complete wound debridement or for a maximum of 4 weeks with twice-daily applications of collagenase or fibrinolysin/deoxyribonuclease . The primary endpoint was percentage change in the yellow or black wound surface . Secondary endpoints were wound environment , margins , depth , pocketing , area and healing . Assessment was by two independent dermatologists who were unaware of the treatment administered and evaluated results from photographs taken at the beginning and end of treatment . RESULTS on intention-to-treat analysis , collagenase gave slightly better results with regard to the primary endpoint in the 121 assessable patients , but this difference was not statistically significant ( P=0.115 ) . Additional efficacy measures did not show any statistically significant difference between the groups . CONCLUSION there was no evidence of a difference between collagenase and fibrinolysin/deoxyribonuclease in the debridement of pressure ulcers The efficacy and tolerability of a new formulation of collagenase ointment ( Iruxol((R ) ) mono ) was determined in a placebo-controlled r and omised double-blind study . 30 patients with chronic ulcers of the lower extremities were treated with either Iruxol((R ) ) mono or placebo ointment base for a minimum of 14 days . Treatment efficacy was determined by evaluating wound debridement , granulation , epithelisation and inflammation using 5-point scales and by measuring wound size . All parameters were assessed daily for the first 2 weeks of treatment and weekly thereafter . For all efficacy parameters , Iruxol((R ) ) mono was significantly superior to placebo ( p < 0.01 ) . Differences reached statistical significance after 6 days of treatment for both debridement and inflammation , and after 4 , 5 and 8 days for granulation , epithelisation and wound size , respectively . In addition to individual parameters , an investigator 's rating of clinical global efficacy also demonstrated the superiority of Iruxol((R ) ) mono ( p < 0.001 ) . Iruxol((R ) ) mono and placebo were both well tolerated . Adverse events were minor and consisted of a burning sensation following ointment application in 3 patients in each group and erythema in a further 2 patients in each group . There were no withdrawals as a result of adverse events in either group . The relationship between adverse event and treatment was considered unlikely in all cases . In conclusion , Iruxol((R ) ) mono was significantly superior to placebo in all estimates of efficacy in wound healing . Iruxol((R ) ) mono was well tolerated with an adverse event profile similar to that of placebo In recent years there has been wider acceptance of aggressive surgical debridement as a means to accelerate closure of diabetic foot ulcers . In a clinical trial by Steed et al.1 involving the use of a topically applied growth factor , thorough surgical debridement of surrounding callus , necrotic ulcer bed , and undermined ulcers ' edges was associated with greater incidence of healing and effectiveness of the therapeutic agent . However , at present there is no established way to judge the appropriate extent of debridement and its performance . Here we describe a scoring system to assess whether debridement has been performed adequately . Our scoring system consists of the following three categories : debridement of a ) callus ; b ) ulcer 's edge undermining ; and c ) wound bed necrotic tissue . We assigned a score of 0 - 2 to each of these categories using the following criteria : 0 = debridement needed but not done , 1 = debridement needed and done , and 2 = debridement not needed . These three scores are then added to give a total ranging from 0 to 6 , with the highest number being the optimal score . This instrument , the Debridement Performance Index , evaluates both the adequacy of debridement and whether the ulcer has been or is being properly debrided . To initiate the validation of this scoring system and determine its predictive value for wound closure by week 12 , we applied it to 143 patients with diabetic foot ulcers who had been treated in a clinical trial involving either st and ard therapy ( n = 65 ) or the application of a bioengineered skin construct ( n = 78 ) . We blindly evaluated sequential digital photographs of each diabetic foot ulcer and applied the Debridement Performance Index score at day 0 , before initiation of either treatment . We found that the lower the baseline Debridement Performance Index the lower the incidence of ultimate wound closure by week 12 ( p = 0.0276 ) . Patients with a Debridement Performance Index between 3 and 6 were 2.4 times more likely to heal than those with a score of 0 - 2 . After controlling for treatment , the Debridement Performance Index was found to be an independent predictor of wound closure ( odds ratio = 2.4 95 % confidence interval = 1.0 - 5.6 ) . In conclusion , this novel scoring system for debridement performance appears to be very promising as a predictive tool for determining outcome in clinical trials and , most likely , in clinical practice A comparative study was performed of the caseinolytic , necrolytic and fibrinolytic activities of a crab collagenase product prepared from the hepatopancreas of the king crab ( Paralithodes camtschatica ) and four enzyme preparations ( trypsin/chymotrypsin and protease complexes isolated from Aspergillus terricola , Carica papaya and pseudomonodaceae ) . This paper reports an in vitro investigation , an in vivo study with rats and a clinical evaluation . It was found that crab collagenase has the highest proteolytic activity measured with respect to fibrin clot and necrotic eschar in vitro although its caseinolytic activity is the lowest . A clinical trial involving 21 patients with leg ulcers confirmed the clinical efficiency of crab collagenase compared with trypsin/ chymotrypsin . The results suggest that crab collagenase is useful in wound debridement 
    Output:
    
A preponderance of evidence from this systematic review confirms that collagenase ointment is a safe and effective choice for debridement of cutaneous ulcers and burn wounds