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The Journal of the American Academy of... Mar 2019Necrotizing soft-tissue infections are caused by a variety of bacterial pathogens that may affect patients at any age or health status. This orthopaedic emergency... (Review)
Review
Necrotizing soft-tissue infections are caused by a variety of bacterial pathogens that may affect patients at any age or health status. This orthopaedic emergency initially presents with nonspecific signs such as erythema and edema. As the disease progresses, classic signs such as bullae, cutaneous anesthesia, ecchymosis, tense edema, and gas can be seen. A high level of suspicion is needed to properly identify and treat in a timely manner. Pain out of proportion to presentation and rapid progression even with appropriate antibiotic treatment should heighten suspicion of a necrotizing soft-tissue infection. The mainstay of management is extensive débridement and decompression of all necrotic tissue and broad-spectrum antibiotics. Débridements are repeated to ensure that disease progression has been halted. Early surgical débridements should take precedent over transfer because of the high rate of limb loss and mortality as a result of surgical delay.
Topics: Anti-Bacterial Agents; Connective Tissue; Debridement; Decompression, Surgical; Disease Progression; Emergencies; Humans; Necrosis; Orthopedics; Risk Factors; Soft Tissue Infections
PubMed: 30431504
DOI: 10.5435/JAAOS-D-17-00616 -
The Surgical Clinics of North America Oct 2018Necrotizing soft tissue infections (NSTI) are characterized by rapidly progressive infection that causes tissue necrosis with associated sepsis and multisystem organ... (Review)
Review
Necrotizing soft tissue infections (NSTI) are characterized by rapidly progressive infection that causes tissue necrosis with associated sepsis and multisystem organ failure. A rapid diagnosis is essential to decreasing the morbidity and mortality of NSTIs. There must be a high index of suspicion based on history and physical examination. There are no adjunct laboratory values or imaging that have high sensitivity and specificity in the diagnosis of NSTI. The treatment involves emergent, radical surgical debridement of involved tissues and broad spectrum antibiotics. Follow-up should include close monitoring of the wound and repeat debridements in the operating room.
Topics: Anti-Bacterial Agents; Debridement; Humans; Soft Tissue Infections
PubMed: 30243450
DOI: 10.1016/j.suc.2018.05.001 -
Journal of Orthopaedic Trauma Oct 2017Bone defects associated with open fractures require a careful approach and planning. At initial presentation, an emergent irrigation and debridement is required.... (Review)
Review
Bone defects associated with open fractures require a careful approach and planning. At initial presentation, an emergent irrigation and debridement is required. Immediate definitive fixation is frequently safe, with the exception of those injuries that normally require staged management or very severe type IIIB and IIIC injuries. Traumatic wounds that can be approximated primarily should be closed at the time of initial presentation. Wounds that cannot be closed should have a negative pressure wound therapy dressing applied. The need for subsequent debridements remains a clinical judgment, but all nonviable tissue should be removed before definitive coverage. Cefazolin remains the standard of care for all open fractures, and type III injuries also require gram-negative coverage. Both induced membrane technique with staged bone grafting and distraction osteogenesis are excellent options for bony reconstruction. Soft tissue coverage within 1 week of injury seems critical.
Topics: Bone Transplantation; Combined Modality Therapy; Debridement; Female; Fracture Fixation, Internal; Fracture Healing; Fractures, Open; Humans; Injury Severity Score; Male; Patient Care Planning; Prognosis; Plastic Surgery Procedures; Soft Tissue Injuries; Surgical Flaps; Treatment Outcome; Wound Healing
PubMed: 28938387
DOI: 10.1097/BOT.0000000000000980 -
Advances in Skin & Wound Care Feb 2024Wound debridement improves healing in a variety of acute and chronic ulcers. However, there is concern that debridement may trigger pathergy and worsen pyoderma...
BACKGROUND
Wound debridement improves healing in a variety of acute and chronic ulcers. However, there is concern that debridement may trigger pathergy and worsen pyoderma gangrenosum (PG).
OBJECTIVE
To determine whether published evidence supports conservative wound debridement for PG.
DATA SOURCES
The authors reviewed the literature published in MEDLINE through January 2023 using the search germs "pyoderma gangrenosum" and "debridement."
STUDY SELECTION
Articles reporting sharp surgical debridement or maggot debridement for PG were included in the review. The authors also searched the reference sections of the reviewed articles for additional reports on debridement for PG.
DATA EXTRACTION
Clinical data regarding patient status, procedures performed, and patient outcomes were extracted from the selected articles.
DATA SYNTHESIS
There are multiple reports of uncontrolled, active-phase PG wounds worsening after aggressive excisional debridement of viable inflamed tissues. In contrast, there is no evidence indicating that conservative debridement of nonviable necrotic tissue worsens PG wounds, regardless of the disease activity. There are multiple reports of successful debridement and surgical grafting for PG in remission.
CONCLUSIONS
There is no evidence in favor of or against using conservative debridement of nonviable necrotic tissue for a PG wound. Therefore, it should not be considered contraindicated, even in the active phase of the disease.
Topics: Animals; Humans; Debridement; Pyoderma Gangrenosum; Wound Healing; Larva; Necrosis
PubMed: 38241454
DOI: 10.1097/ASW.0000000000000092 -
Plastic and Reconstructive Surgery Sep 2016The establishment of a healthy wound bed through adequate debridement of infected, senescent, and/or devitalized tissue is central to the progression of normal wound... (Review)
Review
BACKGROUND
The establishment of a healthy wound bed through adequate debridement of infected, senescent, and/or devitalized tissue is central to the progression of normal wound healing. Although a variety of surgical and nonsurgical strategies have been proposed, none have proven completely effective in all settings. This review focuses on the principles and techniques of modern debridement practices employed in the management of complex wounds.
METHODS
A comprehensive review of the PubMed/Medline and Ovid databases was performed to identify basic science and clinical studies using key words most relevant to biofilm, debridement, and wound healing. English language articles that were peer reviewed and that met the standard of evidence-based medicine were included. Level of evidence for various debridement approaches was rated utilizing the American Society of Plastic Surgeons Rating Levels of Evidence and Grading Recommendations.
RESULTS
The value of both operative and nonoperative debridement techniques, their indications, and limitations are described. With an emphasis placed on surgical debridement, this review highlights technical adjuncts that can be used to optimize wound bed preparation, including preoperative topical staining of the wound, as well as the use of color-guided endpoints to prevent removal of excess healthy tissue. The indications for using temporizing measures for wound control such as negative pressure wound therapy with and without installation are also discussed.
CONCLUSION
Optimal management requires a multimodal approach that centers around operative debridement and incorporates the use of adjunctive measures to facilitate the removal of infected tissue, biofilm, and/or senescent cells that impede the progression of normal wound healing.
Topics: Debridement; Humans; Surgical Wound; Wound Healing; Wound Infection
PubMed: 27556779
DOI: 10.1097/PRS.0000000000002651 -
The Veterinary Clinics of North... Nov 2017Axial pattern flaps are based on a direct cutaneous artery and vein supplying a segment of skin. They provide a large, robust option for large wound closure. Many... (Review)
Review
Axial pattern flaps are based on a direct cutaneous artery and vein supplying a segment of skin. They provide a large, robust option for large wound closure. Many different axial pattern flaps have been described to provide options for closure of wounds located from the nose to the tail. All axial pattern flaps require good surgical technique and careful attention to detail while developing of the flap.
Topics: Animals; Debridement; Skin; Surgical Flaps; Surgical Wound Dehiscence; Treatment Outcome; Wound Healing
PubMed: 28797554
DOI: 10.1016/j.cvsm.2017.06.008 -
Journal of Wound Care Aug 2014Wound debridement, the removal of contaminated tissue and senescent cells, is the cornerstone in the care of patients with chronic wounds.
Wound debridement, the removal of contaminated tissue and senescent cells, is the cornerstone in the care of patients with chronic wounds.
Topics: Debridement; Humans; Treatment Outcome; Wound Healing; Wound Infection
PubMed: 25139594
DOI: 10.12968/jowc.2014.23.8.381 -
Nature Reviews. Urology Apr 2017Despite advances in the evaluation, treatment, and pathophysiological understanding of necrotizing soft-tissue infections, Fournier's gangrene remains a life-threatening... (Review)
Review
Despite advances in the evaluation, treatment, and pathophysiological understanding of necrotizing soft-tissue infections, Fournier's gangrene remains a life-threatening urological emergency. Although the condition can affect patients of any age and gender, it might be more prevalent in some high-risk groups with certain comorbidities. Several prognostic and diagnostic tools have been developed to assist with clinical decision-making once the diagnosis is made - primarily based on the physician's physical exam and potentially supported by laboratory and imaging findings. Expedited treatment with resuscitation, antibiotic administration, and rapid, wide surgical debridement are key elements of the initial management. These procedures must be followed by meticulous wound care and liberal use of planned subsequent surgical debridements. Once the patient has overcome the associated systemic illness, several reconstructive options for the genitalia and perineum can be considered to improve functionality and cosmesis.
Topics: Anti-Bacterial Agents; Debridement; Female; Fournier Gangrene; Humans; Male; Perineum; Prognosis; Risk Factors; Scrotum
PubMed: 27958393
DOI: 10.1038/nrurol.2016.243 -
British Journal of Community Nursing Dec 2014Maggot debridement therapy is used extensively in the UK in both community and hospital situations, but remains a potentially under-used modality in many wound care... (Review)
Review
Maggot debridement therapy is used extensively in the UK in both community and hospital situations, but remains a potentially under-used modality in many wound care markets. It promotes wound healing by performing three key processes: debridement, disinfection and growth-promoting activity. It can be used for the debridement of non-healing necrotic skin and soft tissue wounds, including pressure ulcers, venous stasis ulcers, neuropathic foot ulcers and non-healing traumatic of post-surgical wounds. With the increase in chronic diabetic foot wounds, maggot debridement therapy is a promising tool for health professionals dealing with difficult wounds. This article presents an overview of the research evidence surrounding maggot debridement therapy that serves as a guide to health professionals who may be users of this form of treatment now and in the future.
Topics: Animals; Debridement; Diptera; Humans; Larva; Skin Care; Wound Healing; Wounds and Injuries
PubMed: 25478859
DOI: 10.12968/bjcn.2014.19.Sup12.S6 -
Journal of Wound Care Jun 2024
Topics: Humans; Debridement; Wounds and Injuries; Wound Healing
PubMed: 38829182
DOI: 10.12968/jowc.2024.33.Sup6b.S1