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Archives of Orthopaedic and Trauma... Sep 2023Studies have shown that debridement, antibiotics, and implant retention (DAIR) is an effective procedure for acute infection of total knee arthroplasty (TKA). This study...
INTRODUCTION
Studies have shown that debridement, antibiotics, and implant retention (DAIR) is an effective procedure for acute infection of total knee arthroplasty (TKA). This study aimed to explore DAIR and one-stage revision for homogenous cohorts with acute postoperative and acute hematogenous infection of TKA, without compelling indications to perform a staged revision.
MATERIALS AND METHODS
This study was an exploratory analysis that used retrospective data from Queensland Health, Australia, for DAIR and one-stage revision of TKA between June 2010 and May 2017 (3-year average follow-up). The re-revision burden, mortality rate, and the cost of the interventions were explored. Costs were expressed in 2020 Australian dollars.
RESULTS
There were 15 (DAIR) and 142 (one-stage) patients with homogenous characteristics in the sample. The re-revision burden for DAIR was 20%, while for one-stage revision it was 12.68%. Two deaths were associated with a one-stage revision and no death was associated with DAIR. The total cost since the index revision of DAIR, $162,939, was higher than for one-stage revision $130,924 (p value = 0.501), due to higher re-revision burden.
CONCLUSIONS
This study would suggest the use of one-stage revision over DAIR for acute postoperative and acute hematogenous infection of TKA. It suggests that there could be other potential criteria which have not been ascertained that need to be considered for optimal DAIR selection. The study indicates the need for more research and, of note, high-quality randomized controlled trials to provide a well-defined treatment protocol with high level of evidence to guide patient selection for DAIR.
Topics: Humans; Anti-Bacterial Agents; Retrospective Studies; Cohort Studies; Debridement; Treatment Outcome; Australia; Prosthesis-Related Infections
PubMed: 37101087
DOI: 10.1007/s00402-023-04891-1 -
Plastic and Reconstructive Surgery.... Aug 2023Diabetic foot ulcers are a significant complication of diabetes, affecting millions globally, and require appropriate antibiotics, surgical debridement, wound care, and...
Diabetic foot ulcers are a significant complication of diabetes, affecting millions globally, and require appropriate antibiotics, surgical debridement, wound care, and metabolic optimization for management. This article presents an innovative hybrid regenerative therapy for reconstructing an infected, traumatized foot wound of a 62-year-old man with diabetes mellitus who presented with a week-old injury after a car accident. At presentation, he had a 14 × 10 cm dorsal foot wound with skin necrosis, pus discharge, and bony instability owing to partial fractures and joint dislocations. Antibiotics were administered to treat multidrug-resistant bacteria and followed by surgical debridement and the application of a portable Velnext negative pressure wound therapy device. Once the wound condition stabilized, hybrid regenerative therapy was performed weekly. Six milliliters platelet-rich plasma and 6 mL platelet-poor plasma were prepared from 27 mL of venous blood mixed with 3 mL sodium citrate and injected into the tendons, soft-tissues, and muscles. Next, the exposed bones and tendons were covered with platelet-rich fibrin and semi-occlusive membranes, and a Velnext negative pressure wound therapy device was applied over them. The wound improved progressively during the subsequent 6 weeks and was finally covered with a split-skin graft. The patient had a successful 18-month postoperative period until now with stable grafts, anatomical restoration, and excellent foot functionality. Thus, hybrid regenerative therapy, encompassing several prevalent methods for healing wounds, has excellent benefits for treating complex diabetic foot ulcers.
PubMed: 37593695
DOI: 10.1097/GOX.0000000000005213 -
Refractory shoulder injury related to vaccine administration: correlation with culture presence of .JSES Reviews, Reports, and Techniques Aug 2023Shoulder pain following intramuscular administration of vaccine is common. However, a small number of patients experience prolonged pain and dysfunction atypical to...
BACKGROUND
Shoulder pain following intramuscular administration of vaccine is common. However, a small number of patients experience prolonged pain and dysfunction atypical to normal transient postvaccination shoulder pain. Shoulder Injury Related to Vaccine Administration (SIRVA) remains incompletely understood, whether a robust immune response to vaccine antigen or inappropriate injection technique with needle placement in synovial or bursal tissue, or some combination of the two. Symptoms overlap with those of () infection but the relationship between the two, if any, has not been evaluated.
METHODS
Clinical case files were reviewed for 3 cases of SIRVA with positive cultures for were reviewed. Presentation, treatment, and clinical outcomes were compared.
RESULTS
In all cases, patients were thin (body mass index < 23), females, who had high injection placement of a vaccine, all patients had positive magnetic resonance imaging findings of increased signal in the subacromial bursa, and/or greater tuberosity. All patients underwent arthroscopic débridement and culture harvest and cultures were positive for . A combination of oral and intravenous antibiotics was used, and all patients demonstrated clinical improvement from the preoperative state.
DISCUSSION
This case series presents 3 patients with refractory SIRVA who ultimately underwent arthroscopic irrigation and débridement with culture biopsy. Each case had culture results positive for and all responded, at least partially, to arthroscopic débridement and intravenous antibiotic therapy. The purpose of this manuscript is to raise awareness of potential coexistence of SIRVA and which may be of assistance to surgeons treating refractory cases of SIRVA.
PubMed: 37588495
DOI: 10.1016/j.xrrt.2023.02.011 -
Eplasty 2023Chronic lower extremity (LE) wounds frequently require significant interventions to close. The success of any method depends on an adequately prepared wound bed, while...
BACKGROUND
Chronic lower extremity (LE) wounds frequently require significant interventions to close. The success of any method depends on an adequately prepared wound bed, while factors including wound size, perfusion, contamination, or exposed tissue structures can thwart efforts. We propose a standardized algorithm of care utilizing an acellular dermal matrix, split-thickness skin graft (STSG), and negative pressure wound therapy (NPWT) for the treatment of LE wounds.
METHODS
This was a single-center, retrospective cohort study examining patients who underwent LE wound debridement, placement of fetal bovine dermis (FBD), and STSG between 2016 and 2022. The primary outcome was wound closure, while secondary outcomes were wound infection and amputation-free survival.
RESULTS
Twenty patients (mean age 59 years, M:F 12:8)-including 24 LE venous ulcers (29.4%), amputation sites (29.4%), diabetic foot ulcers (25.0%), and atypical wounds (16.7%) with an average area of 39.15 cm-underwent debridement and FBD placement followed by STSG a median of 61 days thereafter. Of these patients, 83.3% received NPWT after FBD and STSG with 86% closure. There was successful engraftment in 92% of wounds whose FBD placement was within 2 months of STSG. Of wounds that had <50% engraftment, 75% had a STSG placed over 2 months after FBD placement. Of those patients with post-STSG infection, 75% had the graft placed >2 months after FBD placement, one of which required proximal amputation.
CONCLUSIONS
By following a treatment plan including debridement with treatment of infection, application of FBD with placement of STSG within 2 months thereafter, and reinforcing NPWT, chronic wounds will have an increased rate of successful reepithelialization. Many cases experienced delays from FBD engraftment until STSG application due to schedule and insurance impediments, which led to less favorable outcomes. Therefore, a protocol that involves scheduling the placement of STSG 4 weeks after successful engraftment of FBD has been adopted.
PubMed: 38229961
DOI: No ID Found -
British Journal of Hospital Medicine... Sep 2023Fournier's gangrene is a localised form of necrotising fasciitis affecting the external genitalia, perineal and perianal regions. Although rare, it is associated with...
Fournier's gangrene is a localised form of necrotising fasciitis affecting the external genitalia, perineal and perianal regions. Although rare, it is associated with high rates of morbidity and mortality, so clinician awareness is essential for prompt treatment. Risk factors include diabetes mellitus, hypertension, chronic alcoholism and immunosuppression. Perineal pain in patients with sepsis should be treated with a high level of suspicion and early surgical referral is required as prompt debridement can improve outcomes. Repeated surgical intervention and antimicrobial therapy are often needed and recovery can take a long time, with a long-term impact on quality of life. This article discusses the natural history of Fournier's gangrene, aetiology, risk factors, investigations and treatments with an algorithm to support clinical practice.
PubMed: 37769264
DOI: 10.12968/hmed.2023.0119 -
Indian Journal of Pathology &... Jul 2023Fungal infection is a rare condition in immunocompetent individuals, and it is associated with high rates of morbidity and mortality. We report on a case of cutaneous...
Fungal infection is a rare condition in immunocompetent individuals, and it is associated with high rates of morbidity and mortality. We report on a case of cutaneous phaeohyphomycosis in healthy 25-year-old man. Based on the clinical findings, the case was first thought to be cervico-facial actinomycosis, but Alternaria was identified on the culture after debridement. Simple surgical excision resulted in the complete cure without administration of systemic antifungals.
PubMed: 38391321
DOI: 10.4103/ijpm.ijpm_692_22 -
Medicine May 2024Core decompression of the femoral head is a standard surgical procedure used in the early stages of the femoral head avascular necrosis (AVN) (Steinberg I to III). This...
Core decompression of the femoral head is a standard surgical procedure used in the early stages of the femoral head avascular necrosis (AVN) (Steinberg I to III). This study aimed to determine whether the advantages of osseoscopy-assisted core decompression using a standard arthroscopic set up in the early stages of AVN of the femoral head. Twelve hips of 12 patients who underwent osseoscopy-assisted core decompression and debridement with the diagnosis of AVN of the femoral head were reviewed between 2019 and 2021. The etiology was idiopathic in 2 patients; ten had a history of steroid use. The preoperative and postoperative first month Harris Hip Score (HHS) and visual analogue scale (VAS) were recorded. Standard X-rays, computerized tomography, and magnetic resonance imaging (MRI) were noted at preoperatively and sixth month follow-ups. In a 1-year follow-up, X-rays and MRIs were reviewed. All patients significantly improved in the VAS and HHS after the osseoscopy-assisted core decompression (P = .002). Two of the 12 patients with an initial stage of Steinberg IIC and IIB and one with Steinberg IA had a progressive femoral collapse and, therefore, had a total hip replacement at the end of the follow-up. Nine patients (75%) had satisfactory functional and radiological results in 1-year of follow-up. However, 3 patients (25%) culminated in total hip arthroplasty in a 1-year follow-up. Using an arthroscopic set up during osseoscopy-assisted core decompression surgery of the femoral head AVN has the benefits of direct visualization and accurate debridement of the involved area. The osseoscopy-assisted core decompression technique avoids excessive debridement of the healthy bone tissue adjacent to the necrotic area.
Topics: Humans; Femur Head Necrosis; Debridement; Female; Male; Decompression, Surgical; Adult; Middle Aged; Retrospective Studies; Arthroscopy; Treatment Outcome; Magnetic Resonance Imaging
PubMed: 38728470
DOI: 10.1097/MD.0000000000038043 -
International Wound Journal Jun 2024Necrotizing fasciitis (NF) is a rare, dangerous, potentially fatal infectious disease of soft tissue. The treatment consists of antibiotic therapy, surgical debridement... (Review)
Review
Necrotizing fasciitis (NF) is a rare, dangerous, potentially fatal infectious disease of soft tissue. The treatment consists of antibiotic therapy, surgical debridement and subsequent reconstruction. Hyperbaric oxygen (HBO) therapy has been applied in NF patients recently, so our aim was to gather the findings and outcomes for HBO therapy. A PubMed and Google Scholar literature search was conducted regarding the effect of HBO therapy in patients with NF following key words: 'necrotizing fasciitis' AND 'maxillofacial region' OR 'head and neck' AND 'hyperbaric oxygen' OR 'HBO'. A total of 3333 studies have been identified, of which only 16 articles met the inclusion criteria of this review. A conclusion was made, that aggressive combinations of antibiotics and surgical debridement followed by incorporation of HBO therapy, as an adjuvant treatment, in patients with NF and in company by immunoglobulin therapy are showing promising results. In addition, multi-centric studies should be in consideration for further research.
Topics: Humans; Anti-Bacterial Agents; Debridement; Fasciitis, Necrotizing; Hyperbaric Oxygenation; Treatment Outcome
PubMed: 38888249
DOI: 10.1111/iwj.14915 -
Journal of Personalized Medicine Aug 2023It is essential to investigate patients post-surgery using functional surveys like the American Shoulder and Elbow Surgeons Shoulder (ASES) and the Constant-Murley...
It is essential to investigate patients post-surgery using functional surveys like the American Shoulder and Elbow Surgeons Shoulder (ASES) and the Constant-Murley shoulder (CMS) scores, as well as clinical tests, such as the Internal Rotation and Shift (IRO/Shift) and Jobe tests. In this study, 51 out of an initial 87 patients underwent an arthroscopic supraspinatus repair (22 single-row, 16 double-row, 13 debridement). Testing occurred pre-surgery, and 3 and 6 months post-surgery. Both surveys showed significant improvements over time among all 87 patients, but there were no differences between groups (lesion/no lesion) ( > 0.815) or time × group ( > 0.895). The IRO/Shift test showed a stronger ability to distinguish between both groups (positive vs. negative) with respect to the ASES and CMS scores over time, but the Jobe test did not ( > 0.100). Improvements in the CMS scores and the Jobe test were lower following repair compared to the ASES and IRO/Shift test. Most patients returned to adequate levels of functional abilities at 6 months post-surgery. The time required to return to activities of daily living and negative clinical tests was longer for the double-row repair patients compared to the single-row and debridement groups. In conclusion, both the functional surveys and the clinical tests demonstrated improvements following surgery.
PubMed: 37763072
DOI: 10.3390/jpm13091304 -
Medicina (Kaunas, Lithuania) Mar 2024Periprosthetic joint infection is a feared complication after the megaprosthetic reconstruction of oncologic and non-oncologic bone defects of including the knee or hip... (Review)
Review
Periprosthetic joint infection is a feared complication after the megaprosthetic reconstruction of oncologic and non-oncologic bone defects of including the knee or hip joint. Due to the relative rarity of these procedures, however, optimal management is debatable. Considering the expanding use of megaprostheses in revision arthroplasty and the high revision burden in orthopedic oncology, the risk of PJI is likely to increase over the coming years. In this non-systematic review article, we present and discuss current management options and the associated results focusing on studies from the last 15 years and studies from dedicated centers or study groups. The indication, surgical details and results in controlling infection are presented for debridement, antibiotics, irrigation and retention (DAIR) procedure with an exchange of the modular components, single-stage implant exchange, two-stage exchanges and ablative procedures.
Topics: Humans; Prosthesis-Related Infections; Debridement; Arthroplasty, Replacement, Hip; Anti-Bacterial Agents; Reoperation; Arthroplasty, Replacement, Knee; Knee Prosthesis; Hip Prosthesis; Therapeutic Irrigation
PubMed: 38674229
DOI: 10.3390/medicina60040583