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Journal of Wound Care Jun 2024Debridement is key to removing devitalised tissue, debris and biofilm as part of wound-bed preparation. Unlike many other methods of debridement, mechanical debridement... (Observational Study)
Observational Study
BACKGROUND
Debridement is key to removing devitalised tissue, debris and biofilm as part of wound-bed preparation. Unlike many other methods of debridement, mechanical debridement with a pad is effective enough to be used independently without an adjunctive method of debridement, while being more accessible than other standalone options.
OBJECTIVE
To explore the clinical performance and safety of a debridement pad with both abrasive and non-abrasive surfaces in daily clinical practice.
METHODS
This was a prospective, non-controlled, non-randomised, single-arm, open-label, multicentred observational evaluation. Inclusion criteria were wounds >4 cm covered with at least 30% debris, necrotic tissue or slough in patients aged ≥18 years. The treatment protocol comprised a single application of the debridement pad. The primary outcome measure was the amount of necrotic tissue, slough or debris in the wound bed. Secondary outcomes included the appearance of the wound bed, edges and periwound skin; self-reported pain scores; foreseeable negative impacts; and clinician satisfaction.
RESULTS
A total of 62 participants with a variety of wound types were included in the analysis. Most wounds (87%) had been present for over 3 months and had high or moderate exudate levels (90%). A significant reduction was observed in all three parameters: necrotic tissue (p=0.043), slough (p<0.001) and debris (p<0.001). Necrotic tissue, slough and debris showed mean relative reductions of 40%, 72% and 40%, respectively. Of participants, 84% did not experience an increase in pain during the debridement procedure.
CONCLUSION
This clinical real-world data shows the debridement pad to be an effective and well-tolerated device for debridement and wound bed preparation.
Topics: Humans; Debridement; Male; Prospective Studies; Female; Middle Aged; Aged; Adult; Wound Healing; Wounds and Injuries; Aged, 80 and over; Necrosis
PubMed: 38843013
DOI: 10.12968/jowc.2024.0162 -
Critical Care Nurse Aug 2015
Review
Topics: Critical Care Nursing; Debridement; Humans; Surgical Wound Infection; Treatment Outcome
PubMed: 26232805
DOI: 10.4037/ccn2015658 -
Der Chirurg; Zeitschrift Fur Alle... May 2020Necrotizing fasciitis is a fulminant and potentially life-threatening infection of the skin and soft tissue. It is usually caused by a combination of different...
Necrotizing fasciitis is a fulminant and potentially life-threatening infection of the skin and soft tissue. It is usually caused by a combination of different bacteria and is often due to assumed minor trauma. Clinically, only relatively insignificant skin changes are initially present, such as blistering or erythema. They are often accompanied by excessive pain. In the further course, the massive systemic reaction becomes predominant. The diagnosis of necrotizing fasciitis is primarily clinical, which can be supported by laboratory parameters (LRINEC score) and computed tomography imaging. Decisive for the prognosis is the immediate initiation of surgical treatment by radical debridement. Additionally, the calculated administration of a combination of different antibiotics should be initiated. As part of the further complex intensive care treatment, a regular reevaluation of the wounds is carried out. Multiple débridements are always necessary until plastic surgery for defect coverage can be carried out.
Topics: Debridement; Emergency Service, Hospital; Fasciitis, Necrotizing; Humans; Prognosis; Skin; Surgery, Plastic
PubMed: 32296864
DOI: 10.1007/s00104-020-01161-3 -
Der Unfallchirurg Oct 2020Necrotizing fasciitis is a fulminant and potentially life-threatening infection of the skin and soft tissue. It is usually caused by a combination of different...
Necrotizing fasciitis is a fulminant and potentially life-threatening infection of the skin and soft tissue. It is usually caused by a combination of different bacteria and is often due to assumed minor trauma. Clinically, only relatively insignificant skin changes are initially present, such as blistering or erythema. They are often accompanied by excessive pain. In the further course, the massive systemic reaction becomes predominant. The diagnosis of necrotizing fasciitis is primarily clinical, which can be supported by laboratory parameters (LRINEC score) and computed tomography imaging. Decisive for the prognosis is the immediate initiation of surgical treatment by radical debridement. Additionally, the calculated administration of a combination of different antibiotics should be initiated. As part of the further complex intensive care treatment, a regular reevaluation of the wounds is carried out. Multiple débridements are always necessary until plastic surgery for defect coverage can be carried out.
Topics: Debridement; Emergency Service, Hospital; Fasciitis, Necrotizing; Humans; Prognosis; Skin; Surgery, Plastic
PubMed: 32968833
DOI: 10.1007/s00113-020-00869-5 -
Journal of Comparative Effectiveness... Feb 2018Chronic dermal ulcers affect approximately 2.4-4.5 million people in the USA and are associated with loss of function, decreased quality of life and significant... (Comparative Study)
Comparative Study Meta-Analysis Review
Chronic dermal ulcers affect approximately 2.4-4.5 million people in the USA and are associated with loss of function, decreased quality of life and significant economic burden. Debridement is a critical component of wound care involving removal of nonviable tissue from chronic wounds to stimulate the granulation and epithelialization process. Clostridial collagenase ointment has been used as a method of wound debridement for more than 50 years and is currently the only enzymatic debriding ointment with US FDA approval. This review discusses the results of recent real-world studies that build upon the evidence demonstrating the clinical effectiveness, cost-effectiveness and safety of clostridial collagenase ointment across wound types and care settings.
Topics: Chronic Disease; Cost-Benefit Analysis; Debridement; Epidemiologic Methods; Humans; Microbial Collagenase; Ointments; Quality of Life; Skin Ulcer; Treatment Outcome; Wound Healing
PubMed: 29076747
DOI: 10.2217/cer-2017-0066 -
Military Medicine Sep 2018Combat extremity injury and amputation is a life threatening injury. Initial surgical care should focus on hemostasis followed by irrigation and debridement of...
Combat extremity injury and amputation is a life threatening injury. Initial surgical care should focus on hemostasis followed by irrigation and debridement of contaminated and nonviable tissue. Preservation of limb length begins at the initial surgical procedure, to include retention of atypical soft tissue flaps for later reconstruction and treatment of proximal fractures. Serial irrigation and debridements are required throughout the MEDEVAC system as the evolving zone of injury becomes more mature, followed by the appropriate timing of closure outside the combat theater.
Topics: Amputation, Surgical; Debridement; Guidelines as Topic; Humans; Limb Salvage; Research Design; Severity of Illness Index; Surgical Flaps; Treatment Outcome
PubMed: 30189055
DOI: 10.1093/milmed/usy075 -
Methods in Molecular Biology (Clifton,... 2021A murine model of corneal epithelial wounding can be performed using simple injury and imaging methods. Here, we describe the creation of a central corneal epithelial...
A murine model of corneal epithelial wounding can be performed using simple injury and imaging methods. Here, we describe the creation of a central corneal epithelial defect using mechanical debridement under ophthalmic microscopic visualization. Subsequent monitoring with vital dye application and slit-lamp bio microscopy (slit-lamp) is described in detail.
Topics: Animals; Corneal Injuries; Debridement; Disease Models, Animal; Epithelium, Corneal; Mice; Mice, Inbred C57BL; Ophthalmologic Surgical Procedures; Wound Healing
PubMed: 32808269
DOI: 10.1007/978-1-0716-0845-6_17 -
Burns : Journal of the International... Sep 2023Bromelain-based enzymatic debridement has emerged as a valuable option to the standard surgical intervention for debridement in burn injuries. Adverse effects on...
OBJECTIVES
Bromelain-based enzymatic debridement has emerged as a valuable option to the standard surgical intervention for debridement in burn injuries. Adverse effects on coagulation parameters after enzymatic debridement have been described. The purpose of this study was to compare the effect of enzymatic and surgical debridement on coagulation.
METHODS
Between 03/2017 and 02/2021 patients with burn injuries with a total body surface area (TBSA) ≥ 1% were included in the study. Patients were categorized into two groups: the surgically debrided group and the enzymatically debrided group. Coagulation parameters were assessed daily for the first seven days of hospitalization.
RESULTS
In total 132 patients with a mean TBSA of 17% were included in this study, of which 66 received enzymatic debridement and 66 received regular surgical-debridement. Patients receiving enzymatic debridement presented significantly higher factor-V concentration values over the first seven days after admission (p = <0.01). Regarding coagulation parameters, we found no difference in INR-, aPTT-, fibrinogen-, factor-XIII- and thrombocyte-concentrations over the first seven days (p = >0.05).
CONCLUSION
Enzymatic debridement in burned patients does not appear to increase the risk of coagulation abnormalities compared with the regular surgical approach.
Topics: Humans; Burns; Debridement; Blood Coagulation Disorders; Bromelains; Skin Transplantation
PubMed: 36566096
DOI: 10.1016/j.burns.2022.11.008 -
Foot and Ankle Clinics Dec 2017Insertional Achilles tendinopathy is a degenerative enthesopathy associated with pain and dysfunction. Nonsurgical management is first attempted for a period of 3 to... (Review)
Review
Insertional Achilles tendinopathy is a degenerative enthesopathy associated with pain and dysfunction. Nonsurgical management is first attempted for a period of 3 to 6 months and may consist of physical therapy with eccentric training and other modalities. Surgical treatment can be successful with a variety of approaches. A thorough debridement through a midline tendon-splitting approach is associated with high satisfaction rates. Flexor hallucis longus transfer to augment the repair is considered in older, heavier patients or if more than 50% of the tendon was debrided. Early functional rehabilitation is associated with excellent outcomes.
Topics: Achilles Tendon; Debridement; Humans; Tendinopathy; Tendon Transfer
PubMed: 29078827
DOI: 10.1016/j.fcl.2017.07.005 -
International Wound Journal Dec 2023In 2012 the European Medicines Agency approved a pineapple stem-derived Bromelain-based debridement concentrate of proteolytic enzymes (NexoBrid®, MediWound Ltd, Yavne,...
In 2012 the European Medicines Agency approved a pineapple stem-derived Bromelain-based debridement concentrate of proteolytic enzymes (NexoBrid®, MediWound Ltd, Yavne, Israel) for adult deep burns. Over 10 000 patients have been successfully treated with NexoBrid® globally, including in the US. The aim of our study is to perform a systematic review of the current literature on Nexobrid® outcomes. We conducted a literature search in PubMed, Google Scholar, Embase, and other search engines (2013-2023). The online screening process was performed by two independent reviewers with the Covidence tool. The protocol was reported using the Preferred Reporting Items for Systematic Review and Meta-Analyses, and it was registered at the International Prospective Register of Systematic Reviews of the National Institute for Health Research. We identified 103 relevant studies of which 34 were found eligible. The included studies report the positive effects of Nexobrid® on burn debridement, functional and cosmetic outcomes, scarring, and quality of life. Also, they validate the high patient satisfaction thanks to enhanced protocols of analgosedation and/or locoregional anaesthesia during Bromelain-based debridement. Two studies investigate potential risks (coagulopathy, burn wound infection) which concluded there is no strong evidence of these adverse events. NexoBrid® is a safe, selective, non-surgical eschar removal treatment modality. The benefits of Bromelain-based debridement are faster debridement and healing times, reduced operations, length of stay, cases of sepsis, blood transfusions, and prevention of compartment syndrome. Existing evidence suggests that the indications and the role of Bromelain-based debridement are expanding to cover "off-label" cases with significant benefits to the global healthcare economy.
Topics: Adult; Humans; Bromelains; Burns; Debridement; Patient Safety; Quality of Life; Systematic Reviews as Topic
PubMed: 37455553
DOI: 10.1111/iwj.14308