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The Lancet. Infectious Diseases Mar 2023The incidence of necrotising soft-tissue infections has increased during recent decades such that most physicians might see at least one case of these potentially... (Review)
Review
The incidence of necrotising soft-tissue infections has increased during recent decades such that most physicians might see at least one case of these potentially life-threatening infections in their career. Despite advances in care, necrotising soft-tissue infections are still associated with high morbidity and mortality, underlining a need for continued education of the medical community. In particular, failure to suspect necrotising soft-tissue infections, fuelled by poor awareness of the disease, promotes delays to first surgical debridement, amplifying disease severity and adverse outcomes. This Review will focus on practical approaches to management of necrotising soft-tissue infections including prompt recognition, initiation of specific management, exploratory surgery, and aftercare. Increased alertness and awareness for these infections should improve time to diagnosis and early referral to specialised centres, with improvement in the prognosis of necrotising soft-tissue infections.
Topics: Humans; Fasciitis, Necrotizing; Debridement; Soft Tissue Infections; Prognosis; Referral and Consultation
PubMed: 36252579
DOI: 10.1016/S1473-3099(22)00583-7 -
Advances in Skin & Wound Care Apr 2021To present the 2021 update of the Wound Bed Preparation paradigm.
GENERAL PURPOSE
To present the 2021 update of the Wound Bed Preparation paradigm.
TARGET AUDIENCE
This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.
LEARNING OBJECTIVES/OUTCOMES
After participating in this educational activity, the participant will: 1. Apply wound assessment strategies. 2. Identify patient concerns about wound care. 3. Select management options for healable, nonhealable, and maintenance wounds.
Topics: Debridement; Education, Continuing; Humans; Wound Healing; Wounds and Injuries
PubMed: 33739948
DOI: 10.1097/01.ASW.0000733724.87630.d6 -
The Veterinary Clinics of North... Sep 2015Wound care requires an understanding of normal wound healing, causes of delays of wound healing, and the management of wounds. Every wound must be treated as an... (Review)
Review
Wound care requires an understanding of normal wound healing, causes of delays of wound healing, and the management of wounds. Every wound must be treated as an individual with regard to cause, chronicity, location, and level of microbial contamination, as well as patient factors that affect wound healing. Knowledge of wound care products available and when negative pressure wound therapy and drain placement is appropriate can improve outcomes with wound healing. Inappropriate product use can cause delays in healing. As a wound healing progresses, management of a wound and the bandage material used must evolve.
Topics: Animals; Anti-Bacterial Agents; Bandages; Cat Diseases; Cats; Debridement; Dog Diseases; Dogs; Drainage; Wound Healing; Wounds and Injuries
PubMed: 26022525
DOI: 10.1016/j.cvsm.2015.04.009 -
Plastic and Reconstructive Surgery Jan 2021Wounds have been one of the most prominent pathologies since the beginning of humanity. For the last 5 decades, a drastic improvement of healing has been observed,...
Wounds have been one of the most prominent pathologies since the beginning of humanity. For the last 5 decades, a drastic improvement of healing has been observed, thanks to new medical devices based on fluid aspiration capacities and the development of negative pressure wound therapy. Negative-pressure wound therapy was initially designed for a double action, fluid aspiration and mechanical stimulation of wound edges by a foam. Successive technical evolutions of negative pressure wound therapy were declined since 1997 when Argenta and Morykwas first presented their solution. The adjunct of instillation in 2009 was considered as the first interactive dressing, allowing topical wound solutions to sequentially reach the wound, in alternance with negative pressure. Other devices based on the same principle were designed to prevent postoperative infections when placed over a suture after surgery. This long evolution could enhance the armamentarium of possible solutions, considerably reducing the wound healing time.
Topics: Anti-Infective Agents, Local; Bandages; Chronic Disease; Crystalloid Solutions; Debridement; Free Tissue Flaps; History, 20th Century; History, 21st Century; Humans; Instillation, Drug; Limb Salvage; Negative-Pressure Wound Therapy; Peripheral Arterial Disease; Skin Transplantation; Surgical Wound Infection; Therapeutic Irrigation; Treatment Outcome; Wound Healing; Wounds and Injuries
PubMed: 33347058
DOI: 10.1097/PRS.0000000000007628 -
World Journal of Emergency Surgery :... Mar 2023To determine the efficacy of hyperbaric oxygen therapy (HBO) in the treatment of necrotizing soft tissue infections (NSTI), we conducted a meta-analysis of the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
To determine the efficacy of hyperbaric oxygen therapy (HBO) in the treatment of necrotizing soft tissue infections (NSTI), we conducted a meta-analysis of the available evidence.
METHODS
Data sources were PubMed, Embase, Web of Science, Cochrane Library, and reference lists. The study included observational trials that compared HBO with non-HBO, or standard care. The primary outcome was the mortality rate. Secondary outcomes were the number of debridement, amputation rate and complication rate. Relative risks or standardized mean differences with 95% confidence intervals were calculated for dichotomous and continuous outcomes, respectively.
RESULTS
A total of retrospective cohort and case-control studies were included, including 49,152 patients, 1448 who received HBO and 47,704 in control. The mortality rate in the HBO group was significantly lower than that in the non-HBO group [RR = 0.522, 95% CI (0.403, 0.677), p < 0.05]. However, the number of debridements performed in the HBO group was higher than in the non-HBO group [SMD = 0.611, 95% CI (0.012, 1.211), p < 0.05]. There was no significant difference in amputation rates between the two groups [RR = 0.836, 95% CI (0.619, 1.129), p > 0.05]. In terms of complications, the incidence of MODS was lower in the HBO group than in the non-HBO group [RR = 0.205, 95% CI (0.164, 0.256), p < 0.05]. There was no significant difference in the incidence of other complications, such as sepsis, shock, myocardial infarction, pulmonary embolism, and pneumonia, between the two groups (p > 0.05).
CONCLUSION
The current evidence suggests that the use of HBO in the treatment of NSTI can significantly reduce the mortality rates and the incidence rates of complications. However, due to the retrospective nature of the studies, the evidence is weak, and further research is needed to establish its efficacy. It is also important to note that HBO is not available in all hospitals, and its use should be carefully considered based on the patient's individual circumstances. Additionally, it is still worthwhile to stress the significance of promptly evaluating surgical risks to prevent missing the optimal treatment time.
Topics: Humans; Soft Tissue Infections; Hyperbaric Oxygenation; Retrospective Studies; Debridement; Combined Modality Therapy
PubMed: 36966323
DOI: 10.1186/s13017-023-00490-y -
Acta Chirurgica Belgica Aug 2022Early surgical debridement of the deep second and third-degree burns is still the standard of care (SOC) to prepare the wound bed for skin grafting. However, this... (Review)
Review
INTRODUCTION
Early surgical debridement of the deep second and third-degree burns is still the standard of care (SOC) to prepare the wound bed for skin grafting. However, this technique has some drawbacks that explain the growing interest in enzymatic debridement as an alternative. In this article, we provide a historic overview as well as the current state-of-the-art and future prospective of this type of non-surgical debridement.
MATERIALS AND METHODS
A narrative review of the available literature was conducted using a systematic search.
RESULTS
A total of 32 articles were included. The only enzyme mixture still used nowadays for burn eschar removal is bromelain-based. There is increasing evidence that this type of enzymatic debridement is a powerful tool to selectively remove the eschar in deep burns, thereby reducing the need for autologous skin grafting compared to surgical SOC. Moreover, off-label use of enzymatic debridement with NexoBrid (facial, pediatric, and >15%TBSA burns) has proven to be effective and safe.
CONCLUSION
There is increasing evidence that bedside administered NexoBrid, preferably under regional anesthesia, is a powerful tool for selective burn eschar removal. However, the clinical wound bed evaluation post-NexoBrid procedure in relation to the optimal treatment decision-conservative treatment surgery-is not yet completely elucidated. More high-quality prospective clinical trials are necessary to compare enzymatic debridement of objectively confirmed deep burns with the current standard treatment and assess the effectiveness of the eschar removal, the need for surgery, the healing time of such wounds, and the long-term scar quality.
Topics: Burns; Child; Debridement; Humans; Skin; Skin Transplantation; Wound Healing
PubMed: 35440290
DOI: 10.1080/00015458.2022.2068746 -
British Journal of Community Nursing Sep 2021Wound bed preparation is the management of a wound in order to optimise healing and/or facilitate other therapeutic measures. It is the most pivotal step in healing... (Review)
Review
Wound bed preparation is the management of a wound in order to optimise healing and/or facilitate other therapeutic measures. It is the most pivotal step in healing wounds. Early referral to a specialist wound clinic can markedly improve the wound healing process. This overview will discuss the techniques involved in the preparation of the wound bed that will effectively accelerate the healing process. The process begins with a correct diagnosis of the wound and optimising the patient's medical condition. The TIMERS framework is discussed. Wound dressings, including the use of negative-pressure wound therapy, are discussed, along with debridement techniques and agents. The timing of wound intervention and evaluating progress will also be discussed, and wound bed preparation strategies will be included. There has been an added challenge of wound care in the community as a result of the COVID-19 pandemic. The present article provides an overview of how to prepare a wound bed in the community.
Topics: Bandages; COVID-19; Community Health Nursing; Debridement; Humans; Wounds and Injuries
PubMed: 34473537
DOI: 10.12968/bjcn.2021.26.Sup9.S6 -
Journal of Wound Care Jul 2022
Topics: Debridement; Humans
PubMed: 35797251
DOI: 10.12968/jowc.2022.31.Sup7.S3 -
Journal of Wound Care Jun 2024
Topics: Humans; Debridement; Wounds and Injuries; Wound Healing
PubMed: 38829182
DOI: 10.12968/jowc.2024.33.Sup6b.S1 -
Surgical Infections Jun 2020Removal of hardware with irrigation and debridement in patients with surgical site infections (SSIs) is performed commonly. However, the removal of hardware from... (Review)
Review
Removal of hardware with irrigation and debridement in patients with surgical site infections (SSIs) is performed commonly. However, the removal of hardware from patients with SSIs after spinal procedures is controversial. Moreover, primary spinal infections such as spondylodiscitis may require instrumentation along with surgical debridement. The purpose of this article was to evaluate critically and summarize the available evidence related to retention of hardware in patients with deep SSIs, and the use of instrumentation in surgical treatment of primary spinal infections. A literature search utilizing PubMed database was performed. Studies reporting the management of deep SSIs after instrumented spinal procedures, and of primary spinal infections using instrumentation published in peer-reviewed journals were included. Identified publications were evaluated for relevance, and data were extracted from the studies deemed relevant. Because SSIs occur typically during the early post-operative period before stable bony fusion has been achieved, the removal of instrumentation may be associated with instability of the spinal column, pseudarthrosis, progressive deformity, pain, loss of function, and deterioration in the activities of daily living (ADL). Hence, early SSIs after spinal instrumentation are usually treated without removal of hardware. Moreover, primary spinal infections such as spondylodiscitis may require surgical debridement and instrumentation in cases with associated instability. Retaining or using instrumentation in patients with SSIs after spinal procedures or in patients with primary spinal infections, respectively, are commonly practiced in the field of spine surgery. Further evidence is required for the development of definitive algorithms to guide spine surgeons in decision making regarding the fate of instrumentation in the treatment of spinal infections.
Topics: Activities of Daily Living; Anti-Bacterial Agents; Debridement; Foreign Bodies; Humans; Internal Fixators; Retrospective Studies; Spinal Diseases; Spine; Surgical Wound Infection; Time Factors
PubMed: 31855116
DOI: 10.1089/sur.2019.206