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Cartilage Mar 2024Freiberg disease is a type of osteonecrosis of the metatarsal head that predominantly occurs in young females and adolescents, although it may occur at any age. The...
Freiberg disease is a type of osteonecrosis of the metatarsal head that predominantly occurs in young females and adolescents, although it may occur at any age. The pathophysiology is multifactorial and may involve trauma, altered foot biomechanics, systemic disorders, and arterial insufficiency. The most typical location is the second metatarsal head, but Freiberg disease may also occur in other lesser toes. Nonoperative treatment is best applied in the early stage of the disease; if this is ineffective, surgical treatment is recommended. Currently available surgical procedures include debridement, osteotomy, osteochondral grafting, microfracture, interposition arthroplasty, implant arthroplasty, and metatarsal shortening arthroplasty. In this article, we propose a treatment algorithm for Freiberg disease based on the current literature and expert opinion.
Topics: Female; Adolescent; Humans; Metatarsal Bones; Osteotomy; Fractures, Stress; Arthroplasty; Debridement
PubMed: 37815268
DOI: 10.1177/19476035231205676 -
Bone & Joint Open Aug 2023The standard of wide tumour-like resection for chronic osteomyelitis (COM) has been challenged recently by adequate debridement. This paper reviews the evolution of...
AIMS
The standard of wide tumour-like resection for chronic osteomyelitis (COM) has been challenged recently by adequate debridement. This paper reviews the evolution of surgical debridement for long bone COM, and presents the outcome of adequate debridement in a tertiary bone infection unit.
METHODS
We analyzed the retrospective record review from 2014 to 2020 of patients with long bone COM. All were managed by multidisciplinary infection team (MDT) protocol. Adequate debridement was employed for all cases, and no case of wide resection was included.
RESULTS
A total of 53 patients (54 bones) with median age of 45.5 years (interquartile range 31 to 55) and mean follow-up of 29 months (12 to 59) were included. In all, ten bones were Cierny-Mader type I, 39 were type III, and five were type IV. All patients were treated with single-staged management, except for one (planned two-stage stabilization). Positive microbial cultures grew in 75%. Overall, 46 cases (85%) had resolution of COM after index procedure, and 49 (90.7%) had resolution on last follow-up. Four patients (7%) underwent second surgical procedure and six patients (11%) had complications.
CONCLUSION
We challenge the need for wide tumour-like resection in all cases of COM. Through detailed preoperative evaluation and planning with MDT approach, adequate debridement and local delivery of high concentration of antibiotic appears to provide comparable outcomes versus radical debridement.
PubMed: 37611921
DOI: 10.1302/2633-1462.48.BJO-2023-0017.R1 -
Burns : Journal of the International... Sep 2023Removal of necrotic tissue is a vital step in the treatment of full-thickness burn wounds, with surgical debridement being the most effective method. Since minor burn...
INTRODUCTION
Removal of necrotic tissue is a vital step in the treatment of full-thickness burn wounds, with surgical debridement being the most effective method. Since minor burn wounds are typically treated on an outpatient basis where surgical capabilities can be limited there is a need for alternative treatment options. In this study we aim to evaluate the use of amino acid buffered hypochlorite (AABH) as a chemical enhancement for wound debridement in a porcine infected burn wound model.
METHOD
A total of 60 full-thickness burn wounds, 3 cm in diameter, were created on four pigs using a standardized burn device. The wounds were inoculated with 10 colony-forming units (CFU) of S. aureus. The experimental groups included wounds debrided with a plastic curette, wounds debrided after pretreatment with AABH, and control wounds wiped with gauze. Wounds were treated twice per week for three weeks. Debridement, healing, and infection parameters were evaluated over time.
RESULTS
After one week, but not after two and three weeks, the curette and AABH groups had higher debrided weights compared to control (p < 0.05). Percentage of wound area adequately cleared from necrotic tissue was higher in the AABH-group compared to the curette-group and control, after one week. The earliest healing was measured in the AABH group after two weeks (5 % of wounds), which also had the most healed wounds after three weeks (55 %). In both the AABH and the curette groups, bacterial load had fallen below 10 CFU/g after two weeks. No CFU were detectable in the AABH group after three weeks. The AABH-group was also the easiest to debride.
CONCLUSION
Our results indicate that AABH facilitates wound debridement and could be a helpful addition to an effective treatment modality for removal of necrotic tissue in full-thickness burns.
Topics: Animals; Swine; Burns; Debridement; Hypochlorous Acid; Staphylococcus aureus; Amino Acids; Wound Infection; Soft Tissue Injuries
PubMed: 36543728
DOI: 10.1016/j.burns.2022.11.011 -
Cureus May 2024Root canal treatment of vital, non-infected teeth can often be completed in a single visit, negating the necessity for dressing and provisionalization. Conversely, cases... (Review)
Review
Root canal treatment of vital, non-infected teeth can often be completed in a single visit, negating the necessity for dressing and provisionalization. Conversely, cases involving infected canals typically demand multiple visits, during which antibacterial medicaments are applied, making effective provisionalization crucial for varying durations. The key components of a successful root canal treatment include adequate canal shape to promote efficient obturation, thorough chemical and mechanical debridement, and complete removal of pulp tissue remnants and bacteria. The primary cause of pain following the initiation of endodontic treatments is often attributed to inadequate debridement or incomplete removal of the pulp tissue, closely followed by insufficient temporary restorations. This review aims to comprehensively overview provisionalization materials used during and immediately after endodontic procedures.
PubMed: 38894783
DOI: 10.7759/cureus.60591 -
Scientific Reports Aug 2023At present, enzyme debridement preparation has shown a good curative effect on eschar removal of burn wounds. Keratinase has shown great potential in enzymatic...
At present, enzyme debridement preparation has shown a good curative effect on eschar removal of burn wounds. Keratinase has shown great potential in enzymatic debridement because of its good fibrin-degrading ability. In this study, the debridement of keratinase was examined by using a third degree burn wound model in rats. We observed the wound, and keratinase shortened the time of eschar dissolution after debridement. Histopathology and immunofluorescence staining showed that the eschar in the keratinase group became thinner, inflammatory cell infiltration in the wound increased, the fluorescence intensity of the macrophage surface marker CD68 increased, and the CD163/CD86 ratio increased. In bone marrow-derived macrophages (BMDMs), there was no significant difference in the activity of CCK-8 in cells in the keratinase group compared with the control group. The fluorescence intensity of the keratinase group was higher than that of the control group. At 12 h, the cell scratches were obviously closed. The number of migrated Transwell cells increased. Flow cytometry and immunofluorescence analysis showed increased expression of CD206 and Arg-1 and decreased expression of CD86 and iNOS. The gene expression of the Arg-1, iNOS and IL-10 was increased, as shown by qPCR. The secretion of IL-10 was increased and TNF-α was decreased, as shown by ELISA. We concluded that keratinase dissolution of eschar not only has a hydrolytic effect on eschar but may also affect immune regulation to enhance the migration and phagocytosis of macrophages, promote the polarization of macrophages, and further enhance the effect of eschar dissolution. Therefore, keratinase may have good prospects for the debridement of burn wounds.
Topics: Male; Animals; Rats; Rats, Sprague-Dawley; Solubility; Burns; Macrophages
PubMed: 37580372
DOI: 10.1038/s41598-023-39765-4 -
Cureus Sep 2023Cervical necrotizing fasciitis is an immensely progressive, difficult-to-diagnose soft tissue infection of the fascial planes, skin, and subcutaneous tissue. It has...
Cervical necrotizing fasciitis is an immensely progressive, difficult-to-diagnose soft tissue infection of the fascial planes, skin, and subcutaneous tissue. It has marked morbidity and mortality. In this case report, we analyzed the risk factors, laboratory indices, and treatment modalities that affect the outcome of this fatal disease. This is a retrospective case series of cases admitted within a short span of six months between January and June 23. The cases were followed up monthly for three months, and the diagnosis was made on a clinical, pathological, radiological, and histopathological basis. All the cases were managed with neck exploration and aggressive surgical debridement in an emergency department, dressing of the wound with hydrogen peroxide and betadine twice daily, triple broad-spectrum antibiotic therapy for polymicrobial infection, and tight glycemic control. There were no complications, and all the patients survived. We report our cases of cervical necrotizing fasciitis that had similar presentations but varied outcomes. Here, we would like to advocate the importance of immediate management in the form of neck exploration and debridement at the earliest after the diagnosis has been established. Hyperglycemia should be brought under control, and daily aseptic dressing with removal of the slough and source of infection would greatly affect the outcome of this deadly disease.
PubMed: 37809201
DOI: 10.7759/cureus.44678 -
Cureus Feb 2024Introduction Amputations and recurrent infections are two terrible outcomes of open fractures that can leave patients with permanent impairments. Rapid and effective...
Introduction Amputations and recurrent infections are two terrible outcomes of open fractures that can leave patients with permanent impairments. Rapid and effective treatment can protect patients from open fracture sequelae and the long-term financial burden these injuries frequently cause. Over 50% of open fractures are caused by high energy trauma, which most frequently happens in car accidents or severe falls. There hasn't been much research done on the first bacterial ecology of open fracture wounds in the Indian environment. Therefore, the need of the current assignment was to assess the effectiveness of pre-debridement and post-debridement culture in open fractures of the extremities. Methodology A prospective comparative study was carried out with 65 patients who were hospitalized from the OPD and Emergency departments at the R. L. Jalappa Hospital and Research Center. The time frame of study was between December 2020 and July 2022. Prior to the trial, each participant's written informed consent was obtained and strict protocol was followed in accordance with the Institutional Ethics Committee. Results Among the study participants, the majority of cases (26.15%) belonged to the 21-30 years of age group. A total of 14 participants belonged to the 41-50 years of age group. Out of the total, nine patients were aged less than 20 years. Out of the total, in pre-debridement culture the majority of cases had presence of growth of Staphylococcus aureus followed by Acinetobacter species, Enterobacter species and Pseudomonas species. Only six patients had growth of Klebsiella species. After debridement and treatment for bacterial infection, on subsequent culture examination, no growth was found among 61 patients. Although in four patients, there was presence of Pseudomonas species, Enterobacter species and Proteus microorganisms. Conclusion Although the validity of sequential cultures has been questioned in a number of investigations, this study has demonstrated that debridement cultures have a significant impact in postoperative infection. Debridement culture is therefore advised to offer information about the selection of antimicrobial medication, which when paired with a complete wound debridement will permit an early wound closure and better overall outcome functionally.
PubMed: 38524069
DOI: 10.7759/cureus.54778 -
Innovative Surgical Sciences Jun 2023The aim was to reflect the established interdisciplinary aspects of general/abdominal and plastic surgery by means of a narrative review. Methods: (i) With specific... (Review)
Review
INTRODUCTION
The aim was to reflect the established interdisciplinary aspects of general/abdominal and plastic surgery by means of a narrative review. Methods: (i) With specific references out of the medical literature and (ii) own clinical and perioperative as well as operating technical and tactical management experiences obtained in surgical daily practice, we present a choice of options for interdisciplinary cooperation that could be food of thought for other surgeons.
CONTENT
- Decubital ulcers require pressure relieve, debridement and plastic surgery coverage, e.g., by a rotation flap plasty, V-Y flap or "tensor-fascia-lata" (TFL) flap depending on localization (sacral/gluteal defects, ischiadic tuber). - Coverage of soft tissue defects, e.g., after lymph node dissection, tumor lesions or disturbance of wound healing can be managed with fasciocutaneous or muscle flaps. - Bariatric surgery: Surgical interventions such as butt lift, tummy tuck should be explained and demonstrated in advance and performed commonly after reduction of the body weight. - Abdominoperineal rectum extirpation (APE): Holm's procedure with greater circumferential extent of resection at the mesorectum and the insertion site of the levator muscle at the anal sphicter muscle resulting in a substantial defect is covered by myocutaneous flap plasty. - Hernia surgery: Complicated/recurrent hernias or abdominal wall defect can be covered by flap plasty to achieve functional reconstruction, e.g., using innervated muscle. Thus, abdominal wall can respond better onto changes of pressure and tension. - Necrotising fasciitis: Even in case of suspicious fasciitis, an immediate radical debridement must be performed, followed by intensive care with calculated antibiotic treatment; after appropriate stabilization tissue defects can be covered by mesh graft of flap plasty. - Soft tissue tumor lesions cannot be resected with primary closure to achieve appropriate as intended R0 resection status by means of local radical resection all the time - plastic surgery expertise has to be included into interdisciplinary tumor concepts. - Liposuction/-filling: Liposuction can be used with aesthetic intention after bariatric surgery or for lipedema. Lipofilling is possible for reconstruction and for aesthetic purpose. - Reconstruction of lymphatic vessels: Lymphedema after tumor operations interrupting or blocking lymphatic drainage can be treated with microsurgical reconstructions (such as lympho-venous anastomoses, lympho-lymphatic anastomoses or free microvascular lymph node transfer). - Microsurgery: It is substantial part of modern reconstructive plastic surgery, i.e., surgery of peripheral nerves belongs to this field. For visceral surgery, it can become important for reconstruction of the recurrent laryngeal nerve. - Sternum osteomyelitis: Radical debridement (eventually, complete sternal resection) with conditioning of the wound by vacuum-assisted closure followed by plastic surgery coverage can prevent chronification, threatening mediastinitis, persisting infectious risk, long-term suffering or limited quality of life.
SUMMARY
The presented selection of single topics can only be an excerpt of all the options for surgical cooperation in daily clinical and surgical practice.
OUTLOOK
An interdisciplinary approach of abdominal and plastic surgery is characterized by a highly developed cooperation in common surgical interventions including various techniques and tactics highlighting the specifics of the two fields.
PubMed: 38058780
DOI: 10.1515/iss-2023-0042 -
Journal of Surgical Case Reports Aug 2023We present the first case report of prosthetic joint infection (PJI) caused by . Our patient is a 74-year-old male who underwent primary total hip replacement for right...
We present the first case report of prosthetic joint infection (PJI) caused by . Our patient is a 74-year-old male who underwent primary total hip replacement for right hip pain. His recovery was uneventful until 6 weeks postoperatively when he presented to his routine outpatient appointment with significant erythema, swelling, and tenderness over his right hip wound. Based on the acuity of his symptoms and the radiological findings, it was determined that the patient should undergo debridement, antibiotics, and implant retention (DAIR procedure). A consensus decision was also made at our PJI multidisciplinary meeting to treat him with 12 weeks of IV antibiotics. After completing this 12 weeks course of IV Vancomycin, his inflammatory markers returned to normal limits. At 6 months follow-up, our patient was mobilizing independently without any signs of infection recurrence. His radiographs showed the implant was in a satisfactory position with no evidence of loosening. This case adds to an emerging body of literature describing invasive infections associated with Kocuria species. We have demonstrated the effectiveness of managing this condition with debridement, implant retention, and IV Vancomycin therapy for 12 weeks.
PubMed: 37662443
DOI: 10.1093/jscr/rjad484 -
Arthroscopy Techniques Apr 2024Haglund's deformity refers to the enlargement of the posterosuperior tuberosity of the calcaneus, which can cause debilitating posterior heel pain and swelling....
Haglund's deformity refers to the enlargement of the posterosuperior tuberosity of the calcaneus, which can cause debilitating posterior heel pain and swelling. Calcaneoplasty is indicated for the treatment of Haglund's deformity following a failure of conservative treatment. Endoscopic calcaneoplasty confers a few advantages over open surgery and has been growing in popularity as the preferred technique. This Technical Note presents an endoscopic calcaneoplasty technique with bone debridement followed by treatment with a Topaz radiofrequency device, with the patient in a supine position.
PubMed: 38690328
DOI: 10.1016/j.eats.2024.102912