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Revue Medicale Suisse Dec 2022Fracture-related infection is a feared complication of trauma surgery with potentially major repercussions on quality of life and healthcare systems. Its management is...
Fracture-related infection is a feared complication of trauma surgery with potentially major repercussions on quality of life and healthcare systems. Its management is based on two pillars: a radical surgical debridement along with a targeted long-term antibiotic therapy based on multiple deep tissue samples obtained during the chosen surgical procedure. Multidisciplinary management and early diagnosis are essential for treatment success. The implementation of a standardized definition for fracture-related infections since 2018 has allowed the optimization and streamlining of management algorithms and their validation in the literature. This article provides a comprehensive and in-depth review of recent advances in the diagnosis and management of fracture-related infections.
Topics: Humans; Fracture Fixation, Internal; Surgical Wound Infection; Debridement; Quality of Life; Fractures, Bone; Anti-Bacterial Agents
PubMed: 36515473
DOI: 10.53738/REVMED.2022.18.808.2363 -
The Orthopedic Clinics of North America Jan 2017The optimal treatment of open fractures continues to be an area of debate in the orthopedic literature. Recent research has challenged the dictum that open fractures... (Review)
Review
The optimal treatment of open fractures continues to be an area of debate in the orthopedic literature. Recent research has challenged the dictum that open fractures should be debrided within 6 hours of injury. However, the expedient administration of intravenous antibiotics remains of paramount importance in infection prevention. Multiple factors, including fracture severity, thoroughness of debridement, time to initial treatment, and antibiotic administration, among other variables, contribute to the incidence of infection and complicate identifying an optimal time to debridement.
Topics: Debridement; Fractures, Open; Humans; Operative Time; Surgical Wound Infection
PubMed: 27886680
DOI: 10.1016/j.ocl.2016.08.006 -
Expert Opinion on Biological Therapy 2023Accurate burn depth assessment and early excision of burn eschar with maximal dermal preservation are key concepts in the optimal care of burn injury. Although excision... (Review)
Review
INTRODUCTION
Accurate burn depth assessment and early excision of burn eschar with maximal dermal preservation are key concepts in the optimal care of burn injury. Although excision with knife has long since been standard of care, a newer technique for wound bed preparation utilizing a bromelain-based enzyme has gained popularity worldwide and may offer several advantages.
AREAS COVERED
Here we report the pharmacologic properties, evidence for clinical efficacy, safety, and tolerability of anacaulase-bcdb for the treatment of deep partial thickness and full thickness burns.
EXPERT OPINION
Anacaulase-bcdb is a safe, non-surgical, selective eschar removal agent. It offers advantages over surgical excision of burn with knife and fulfills two unmet needs: burn depth assessment and dermal preservation during excision. Evidence supports a faster time to complete eschar removal; reduced number of operations; reduction in the amount of autografting, length of stay, and blood loss; prevention of burn induced compartment syndrome; and improved cosmetic outcome.
Topics: Humans; Wound Healing; Debridement; Burns; Treatment Outcome; Skin Transplantation
PubMed: 37833828
DOI: 10.1080/14712598.2023.2270903 -
The Cochrane Database of Systematic... Sep 2015Venous ulcers (also known as varicose or venous stasis ulcers) are a chronic, recurring and debilitating condition that affects up to 1% of the population. Best practice... (Review)
Review
BACKGROUND
Venous ulcers (also known as varicose or venous stasis ulcers) are a chronic, recurring and debilitating condition that affects up to 1% of the population. Best practice documents and expert opinion suggests that the removal of devitalised tissue from venous ulcers (debridement) by any one of six methods helps to promote healing. However, to date there has been no review of the evidence from randomised controlled trials (RCTs) to support this.
OBJECTIVES
To determine the effects of different debriding methods or debridement versus no debridement, on the rate of debridement and wound healing in venous leg ulcers.
SEARCH METHODS
In February 2015 we searched: The Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. There were no restrictions with respect to language, date of publication or study setting. In addition we handsearched conference proceedings, journals not cited in MEDLINE, and the bibliographies of all retrieved publications to identify potential studies. We made contact with the pharmaceutical industry to enquire about any completed studies.
SELECTION CRITERIA
We included RCTs, either published or unpublished, which compared two methods of debridement or compared debridement with no debridement. We presented study results in a narrative form, as meta-analysis was not possible.
DATA COLLECTION AND ANALYSIS
Independently, two review authors completed all study selection, data extraction and assessment of trial quality; resolution of disagreements was completed by a third review author.
MAIN RESULTS
We identified 10 RCTs involving 715 participants. Eight RCTs evaluated autolytic debridement and included the following agents or dressings: biocellulose wound dressing (BWD), non-adherent dressing, honey gel, hydrogel (gel formula), hydrofibre dressing, hydrocolloid dressings, dextranomer beads, Edinburgh University Solution of Lime (EUSOL) and paraffin gauze. Two RCTs evaluated enzymatic preparations and one evaluated biosurgical debridement. No RCTs evaluated surgical, sharp or mechanical methods of debridement, or debridement versus no debridement. Most trials were at a high risk of bias.Three RCTs assessed the number of wounds completely debrided. All three of these trials compared two different methods of autolytic debridement (234 participants), with two studies reporting statistically significant results: one study (100 participants) reported that 40/50 (80%) ulcers treated with dextranomer beads and 7/50 (14%) treated with EUSOL achieved complete debridement (RR 5.71, 95% CI 2.84 to 11.52); while the other trial (86 participants) reported the number of ulcers completely debrided as 31/46 (76%) for hydrogel versus 18/40 (45%) for paraffin gauze (RR 0.67, 95% CI 0.45 to 0.99). One study (48 participants) reported that by 12 weeks, 15/18 (84%) ulcers treated with BWD had achieved a 75% to 100% clean, granulating wound bed versus 4/15 (26%) treated with non-adherent petrolatum emulsion-impregnated gauze.Four trials assessed the mean time to achieve debridement: one (86 participants) compared two autolytic debridement methods, two compared autolytic methods with enzymatic debridement (71 participants), and the last (12 participants) compared autolytic with biosurgical debridement; none of the results achieved statistical significance.Two trials that assessed autolytic debridement methods reported the number of wounds healed at 12 weeks. One trial (108 participants) reported that 24/54 (44%) ulcers treated with honey healed versus 18/54 (33%) treated with hydrogel (RR (adjusted for baseline wound diameter) 1.38, 95% CI 1.02 to 1.88; P value 0.037). The second trial (48 participants) reported that 7/25 (28%) ulcers treated with BWD healed versus 7/23 (30%) treated with non-adherent dressing.Reduction in wound size was assessed in five trials (444 participants) in which two autolytic methods were compared. Results were statistically significant in one three-armed trial (153 participants) when cadexomer iodine was compared to paraffin gauze (mean difference 24.9 cm², 95% CI 7.27 to 42.53, P value 0.006) and hydrocolloid compared to paraffin gauze (mean difference 23.8 cm², 95% CI 5.48 to 42.12, P value 0.01). A second trial that assessed reduction in wound size based its results on median differences and, at four weeks, produced a statistically significantly result that favoured honey over hydrogel (P value < 0.001). The other three trials reported no statistically significant results for reduction in wound size, although one trial reported that the mean percentage reduction in wound area was greater at six and 12 weeks for BWD versus a non-adherent dressing (44% versus 24% week 6; 74% versus 54% week 12).Pain was assessed in six trials (544 participants) that compared two autolytic debridement methods, but the results were not statistically significant. No serious adverse events were reported in any trial.
AUTHORS' CONCLUSIONS
There is limited evidence to suggest that actively debriding a venous leg ulcer has a clinically significant impact on healing. The overall small number of participants, low number of studies and lack of meta-analysis in this review precludes any strong conclusions of benefit. Comparisons of different autolytic agents (hydrogel versus paraffin gauze; Dextranomer beads versus EUSOL and BWD versus non-adherent dressings) and Larvae versus hydrogel all showed statistically significant results for numbers of wounds debrided. Larger trials with follow up to healing are required.
Topics: Bandages, Hydrocolloid; Borates; Debridement; Humans; Hydrogel, Polyethylene Glycol Dimethacrylate; Randomized Controlled Trials as Topic; Sodium Hypochlorite; Varicose Ulcer; Wound Healing
PubMed: 26368002
DOI: 10.1002/14651858.CD008599.pub2 -
Journal of Burn Care & Research :... Mar 2024Since 1970 surgeons have managed deep burns by surgical debridement and autografting. We tested the hypothesis that enzymatic debridement with NexoBrid would remove the... (Randomized Controlled Trial)
Randomized Controlled Trial
Since 1970 surgeons have managed deep burns by surgical debridement and autografting. We tested the hypothesis that enzymatic debridement with NexoBrid would remove the eschar reducing surgery and achieve comparable long-term outcomes as standard of care (SOC). In this Phase 3 trial, we randomly assigned adults with deep burns (covering 3-30% of total body surface area [TBSA]) to NexoBrid, surgical or nonsurgical SOC, or placebo Gel Vehicle (GV) in a 3:3:1 ratio. The primary endpoint was complete eschar removal (ER) at the end of the debridement phase. Secondary outcomes were need for surgery, time to complete ER, and blood loss. Safety endpoints included wound closure and 12 and 24-months cosmesis on the Modified Vancouver Scar Scale. Patients were randomized to NexoBrid (n = 75), SOC (n = 75), and GV (n = 25). Complete ER was higher in the NexoBrid versus the GV group (93% vs 4%; P < .001). Surgical excision was lower in the NexoBrid vs the SOC group (4% vs 72%; P < .001). Median time to ER was 1.0 and 3.8 days for the NexoBrid and SOC respectively (P < .001). ER blood loss was lower in the NexoBrid than the SOC group (14 ± 512 mL vs 814 ± 1020 mL, respectively; P < .0001). MVSS scores at 12 and 24 months were noninferior in the NexoBrid versus SOC groups (3.7 ± 2.1 vs 5.0 ± 3.1 for the 12 months and 3.04 ± 2.2 vs 3.30 ± 2.76 for the 24 months). NexoBrid resulted in early complete ER in >90% of burn patients, reduced surgery and blood loss. NexoBrid was safe and well tolerated without deleterious effects on wound closure and scarring.
Topics: Adult; Humans; Burns; Cicatrix; Debridement; Wound Healing
PubMed: 37715999
DOI: 10.1093/jbcr/irad142 -
The International Journal of Lower... Sep 2021Maggot therapy, also known as maggot debridement therapy, larval therapy, biodebridement, or biosurgery, is a type of biotherapy involving the intentional application of...
Maggot therapy, also known as maggot debridement therapy, larval therapy, biodebridement, or biosurgery, is a type of biotherapy involving the intentional application of live, disinfected fly larvae or maggots into the nonhealing wound of a human or animal to debride the necrotic wound, reduce bacterial contamination of the wound as well as enhance the formation of healthy granulation tissue and stimulate healing in nonhealing wounds. In addition, van der Plas et al reported that the use of the medicinal larvae as natural remover of necrotic and infected tissue had prevented amputation in 11 selected patients. In Malaysia, Aaron et al had demonstrated prevention of amputation in 25 patients.
Topics: Animals; Debridement; Dermatologic Surgical Procedures; Humans; Larva; Malaysia; Wound Healing
PubMed: 32524879
DOI: 10.1177/1534734620932397 -
The Veterinary Clinics of North... Nov 2017The importance of initial wound classification and daily reevaluation of wound stage cannot be understated. Products available to enhance healing are categorized based... (Review)
Review
The importance of initial wound classification and daily reevaluation of wound stage cannot be understated. Products available to enhance healing are categorized based on the stage of wound healing to which they exert their effects. After patient stability has been verified, thorough debridement is critical in order to create an environment conducive for healing. The wound environment of acute and chronic wounds differs greatly, often requiring different management approaches.
Topics: Animals; Debridement; Negative-Pressure Wound Therapy; Wound Healing
PubMed: 28781059
DOI: 10.1016/j.cvsm.2017.06.005 -
Journal of Wound Care Aug 2019To determine the clinical effect and consequential levels of health professionals and patient satisfaction with the results of debridement episodes of wounds with...
OBJECTIVE
To determine the clinical effect and consequential levels of health professionals and patient satisfaction with the results of debridement episodes of wounds with visible slough and/or scaly skin using monofilament fibre debridement technology.
METHODS
This was a non-comparative, open label evaluation conducted in static/non-healing acute and chronic wounds with visible slough and/or scaly skin that required debridement. Monofilament fibre debridement technology was applied in 1-2 sequential treatment episodes during normal clinical practice which followed local practice, guidelines or formularies. Following the clinical phase of the evaluation, health professionals were invited to complete an online survey of the clinical outcomes and their satisfaction with them.
RESULTS
Survey questions were answered by 1129 health professionals. Wounds managed using the monofilament fibre debridement technology during this evaluation included leg ulcers (63%), pressure ulcers (10%), dehisced surgical wounds (3%), diabetic foot ulcers (8%) and other wounds (13%). 'Other' wound types included acute dirty wounds, burns, cellulitis, psoriasis, diabetic amputation wounds, dry flaky skin, moisture wounds, trauma, varicose eczema. Of the wounds, 12% were reported as non-static. There was visible change in the wound and/or skin after first use of the monofilament fibre debridement technology in a high proportion of all wound types, and a further increase in the proportion of wounds with visible change after the second use. The visible difference was significant for both static and non-static wounds. User and patient satisfaction with all clinical outcomes were high, whether or not the user and patient had previous experience of monofilament fibre debridement technology.
CONCLUSION
Monofilament fibre debridement technology provides rapid, visible and effective debridement of slough and scaly skin after one application and further visible improvement after two applications in static and non-static wounds. Health professionals and patients report high levels of satisfaction with outcomes following application of the monofilament fibre debridement technology.
Topics: Debridement; Equipment Design; Humans; Practice Patterns, Physicians'; Pressure Ulcer; Surveys and Questionnaires; Treatment Outcome; United Kingdom; Wound Healing
PubMed: 31393801
DOI: 10.12968/jowc.2019.28.8.534 -
Journal of Wound Care Jul 2022Vulvar necrotising fasciitis (VNF) is a severe soft tissue infection associated with substantial morbidity and high mortality. At Stony Brook Medicine, US, patients with... (Review)
Review
OBJECTIVE
Vulvar necrotising fasciitis (VNF) is a severe soft tissue infection associated with substantial morbidity and high mortality. At Stony Brook Medicine, US, patients with known or suspected VNF are treated by a structured multidisciplinary team consisting of members of the Departments of Emergency Medicine and Medicine, the Divisions of Gynecologic Oncology, Burn and Surgical Intensive Care Units, Infectious Disease and Plastic Surgery, and the nursing, nutrition, physical/occupational therapy and social work services.
METHOD
This is a retrospective review of patients presenting to Stony Brook University Hospital with VNF over an 18-month period.
RESULTS
A total of 10 patients were treated for VNF during the study period. All patients were treated by the structured multidisciplinary team, including extensive initial surgical debridement by the gynaecologic oncologists. All patients survived to discharge.
CONCLUSION
The results of this review demonstrated that prompt diagnosis, rapid implementation of appropriate antibiotic coverage, surgical debridement of necrotic tissue, and comprehensive care delivered by a structured multidisciplinary team contributed to positive clinical outcomes and decreased the risk of death from VNF.
Topics: Debridement; Fasciitis, Necrotizing; Female; Humans; Plastic Surgery Procedures; Retrospective Studies; Soft Tissue Infections; Treatment Outcome
PubMed: 35797247
DOI: 10.12968/jowc.2022.31.Sup7.S20 -
The Permanente Journal May 2021Nasal/sinus endoscopy with biopsy/polypectomy/debridement, or Current Procedure Terminology code 31237, is one of the top 10 most frequent and highest billed...
INTRODUCTION
Nasal/sinus endoscopy with biopsy/polypectomy/debridement, or Current Procedure Terminology code 31237, is one of the top 10 most frequent and highest billed otolaryngology procedures among Medicare patients. We analyzed temporal and geographic trends in endoscopic debridement, and correlated them with sinus surgery and balloon sinuplasty trends.
METHODS
Medicare Part-B National Summary Data Files were analyzed from 2000 to 2016 for temporal trends of endoscopic debridement. Medicare Physician and Other Supplier Public Use Files detailing provider information were collected and analyzed from 2012 to 2016. Individual providers performing a reportable number of procedures were included. Linear regression was used to correlate endoscopic debridement, sinus surgery, and balloon sinuplasty procedures.
RESULTS
Between 2000 and 2016, the number of endoscopic debridement procedures increased from 31,579 to 79,762 (6.0% average annual growth). The annual total payments increased from $5,944,582 to $19,438,956 (8.4% average annual growth), with average allowed charge per procedure increasing from $188.24 to $243.71. The greatest and least number of debridement procedures occurred in the Southeast (12,703) and New England (1810) regions, respectively. There was a positive correlation between providers (n = 752) performing endoscopic debridement and sinus surgery (r = 0.31, p < 0.001), which was similar to providers performing endoscopic debridement and balloon sinuplasty (r = 0.29, P < 0.001).
CONCLUSION
Otolaryngologists continue to perform increasing numbers of endoscopic debridements and receive increasing payments. There is some geographic variation in these trends. Among individual providers, there was a positive correlation between the number of endoscopic debridement procedures and both the number of balloon sinuplasty and sinus surgery procedures.
Topics: Aged; Debridement; Endoscopy; Humans; Medicare; Otolaryngologists; Paranasal Sinuses; United States
PubMed: 33970073
DOI: 10.7812/TPP/20.110