***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 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 
    Output:
    
RESULTS Collagenase ointment is more effective than placebo ( inactivated ointment or petrolatum ointment ) for debridement of necrotic tissue from pressure ulcers , leg ulcers , and partial-thickness burn wounds .
Limited evidence suggests that a papain-urea-based ointment  removes necrotic material from pressure ulcers more rapidly than collagenase ointment , but progress toward wound healing appears to be equivocal .
Limited evidence suggests that treatment of partial-thickness burn wounds in children with collagenase ointment may require an equivocal time to treatment with surgical excision and that combination treatment may reduce the need for surgical excision .
Insufficient evidence was found to determine whether collagenase ointment  removes necrotic tissue from leg ulcers more or less rapidly than autolytic debridement enhanced by a polyacrylate dressing .
IMPLICATION S FOR PRACTICE Enzymatic debriding agents are an effective alternative for removing necrotic material from pressure ulcers , leg ulcers , and partial-thickness wounds .
They may be used to debride both adherent slough and eschar .
Clinical experience strongly suggests that combined therapy , such as initial surgical debridement followed by serial debridement using an enzymatic agent or enzymatic debridement along with serial CSWD , is effective for many patients with chronic , indolent , or nonhealing wounds