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World Journal of Emergency Surgery :... Mar 2023To determine the efficacy of hyperbaric oxygen therapy (HBO) in the treatment of necrotizing soft tissue infections (NSTI), we conducted a meta-analysis of the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
To determine the efficacy of hyperbaric oxygen therapy (HBO) in the treatment of necrotizing soft tissue infections (NSTI), we conducted a meta-analysis of the available evidence.
METHODS
Data sources were PubMed, Embase, Web of Science, Cochrane Library, and reference lists. The study included observational trials that compared HBO with non-HBO, or standard care. The primary outcome was the mortality rate. Secondary outcomes were the number of debridement, amputation rate and complication rate. Relative risks or standardized mean differences with 95% confidence intervals were calculated for dichotomous and continuous outcomes, respectively.
RESULTS
A total of retrospective cohort and case-control studies were included, including 49,152 patients, 1448 who received HBO and 47,704 in control. The mortality rate in the HBO group was significantly lower than that in the non-HBO group [RR = 0.522, 95% CI (0.403, 0.677), p < 0.05]. However, the number of debridements performed in the HBO group was higher than in the non-HBO group [SMD = 0.611, 95% CI (0.012, 1.211), p < 0.05]. There was no significant difference in amputation rates between the two groups [RR = 0.836, 95% CI (0.619, 1.129), p > 0.05]. In terms of complications, the incidence of MODS was lower in the HBO group than in the non-HBO group [RR = 0.205, 95% CI (0.164, 0.256), p < 0.05]. There was no significant difference in the incidence of other complications, such as sepsis, shock, myocardial infarction, pulmonary embolism, and pneumonia, between the two groups (p > 0.05).
CONCLUSION
The current evidence suggests that the use of HBO in the treatment of NSTI can significantly reduce the mortality rates and the incidence rates of complications. However, due to the retrospective nature of the studies, the evidence is weak, and further research is needed to establish its efficacy. It is also important to note that HBO is not available in all hospitals, and its use should be carefully considered based on the patient's individual circumstances. Additionally, it is still worthwhile to stress the significance of promptly evaluating surgical risks to prevent missing the optimal treatment time.
Topics: Humans; Soft Tissue Infections; Hyperbaric Oxygenation; Retrospective Studies; Debridement; Combined Modality Therapy
PubMed: 36966323
DOI: 10.1186/s13017-023-00490-y -
Journal of Burn Care & Research :... Mar 2022Mucormycosis is a rare fungal infection with a high mortality rate. It presents with scattered black/necrotic ulcers, white fungal elements, and progression of wounds... (Review)
Review
Mucormycosis is a rare fungal infection with a high mortality rate. It presents with scattered black/necrotic ulcers, white fungal elements, and progression of wounds despite seemingly adequate debridement. Diagnosis is confirmed on wound histology; however, this is often delayed. There is currently no comprehensive review of burn-related mucormycosis within the literature, making this the first article to provide evidence-based treatment guidance. We performed a review of publications from 1946 to the present. There were 151 cases of mucormycosis complicating burns. The mortality rate was 54.5%, and there was a significant increase in mortality with axial body site involvement compared with isolated peripheral involvement. The standard treatment was prompt and radical debridement. Utilization of frozen section to guide debridement aided in clinical decision making. No systemic treatment reached statistical significance; however, amphotericin B trended toward significance. Although there is no strong evidence for topical amphotericin B or hyperbaric oxygen, there may be benefit in some cases. This study recommends early radical debridement in conjunction with the European Confederation of Medical Mycology guidelines of IV liposomal/lipid complex amphotericin B more than 5mg/kg/day, with posaconazole 800 mg daily in divided doses as a salvage or oral step-down.
Topics: Amphotericin B; Antifungal Agents; Burns; Debridement; Humans; Mucormycosis
PubMed: 34874443
DOI: 10.1093/jbcr/irab236 -
Acta Chirurgica Belgica Aug 2022Early surgical debridement of the deep second and third-degree burns is still the standard of care (SOC) to prepare the wound bed for skin grafting. However, this... (Review)
Review
INTRODUCTION
Early surgical debridement of the deep second and third-degree burns is still the standard of care (SOC) to prepare the wound bed for skin grafting. However, this technique has some drawbacks that explain the growing interest in enzymatic debridement as an alternative. In this article, we provide a historic overview as well as the current state-of-the-art and future prospective of this type of non-surgical debridement.
MATERIALS AND METHODS
A narrative review of the available literature was conducted using a systematic search.
RESULTS
A total of 32 articles were included. The only enzyme mixture still used nowadays for burn eschar removal is bromelain-based. There is increasing evidence that this type of enzymatic debridement is a powerful tool to selectively remove the eschar in deep burns, thereby reducing the need for autologous skin grafting compared to surgical SOC. Moreover, off-label use of enzymatic debridement with NexoBrid (facial, pediatric, and >15%TBSA burns) has proven to be effective and safe.
CONCLUSION
There is increasing evidence that bedside administered NexoBrid, preferably under regional anesthesia, is a powerful tool for selective burn eschar removal. However, the clinical wound bed evaluation post-NexoBrid procedure in relation to the optimal treatment decision-conservative treatment surgery-is not yet completely elucidated. More high-quality prospective clinical trials are necessary to compare enzymatic debridement of objectively confirmed deep burns with the current standard treatment and assess the effectiveness of the eschar removal, the need for surgery, the healing time of such wounds, and the long-term scar quality.
Topics: Burns; Child; Debridement; Humans; Skin; Skin Transplantation; Wound Healing
PubMed: 35440290
DOI: 10.1080/00015458.2022.2068746 -
Soins; La Revue de Reference Infirmiere Sep 2022
Topics: Debridement; Detergents; Humans; Wound Healing
PubMed: 36180171
DOI: 10.1016/S0038-0814(22)00235-3 -
Journal of Wound Care Sep 2021
Topics: Debridement; Humans; Therapeutic Irrigation; Wound Healing; Wounds and Injuries
PubMed: 34554854
DOI: 10.12968/jowc.2021.30.Sup9.S8 -
JAMA Surgery Jan 2023For decades, infected or symptomatic pancreatic necrosis was managed by open surgical necrosectomy, an approach that has now been largely supplanted by an array of... (Review)
Review
IMPORTANCE
For decades, infected or symptomatic pancreatic necrosis was managed by open surgical necrosectomy, an approach that has now been largely supplanted by an array of techniques referred to as the step-up approach.
OBSERVATIONS
This review describes the evidence base behind the step-up approach, when to use the different techniques, and their technical basics. The most common treatment strategies are included: percutaneous drainage, video-assisted retroperitoneal debridement, sinus tract endoscopy, endoscopic transgastric necrosectomy, and surgical transgastric necrosectomy. Also included is the evidence base around management of common complications that can occur during step-up management, such as hemorrhage, intestinal fistula, and thrombosis, in addition to associated issues that can arise during step-up management, such as the need for cholecystectomy and disconnected pancreatic duct syndrome.
CONCLUSIONS AND RELEVANCE
The treatment strategies highlighted in this review are those most commonly used during step-up management, and this review is designed as a guide to the evidence base underlying these strategies, as surgeons tailor their therapeutic approach to individual patients.
Topics: Humans; Pancreatitis, Acute Necrotizing; Treatment Outcome; Endoscopy; Drainage; Debridement; Necrosis
PubMed: 36383374
DOI: 10.1001/jamasurg.2022.5695 -
British Journal of Community Nursing Sep 2021Wound bed preparation is the management of a wound in order to optimise healing and/or facilitate other therapeutic measures. It is the most pivotal step in healing... (Review)
Review
Wound bed preparation is the management of a wound in order to optimise healing and/or facilitate other therapeutic measures. It is the most pivotal step in healing wounds. Early referral to a specialist wound clinic can markedly improve the wound healing process. This overview will discuss the techniques involved in the preparation of the wound bed that will effectively accelerate the healing process. The process begins with a correct diagnosis of the wound and optimising the patient's medical condition. The TIMERS framework is discussed. Wound dressings, including the use of negative-pressure wound therapy, are discussed, along with debridement techniques and agents. The timing of wound intervention and evaluating progress will also be discussed, and wound bed preparation strategies will be included. There has been an added challenge of wound care in the community as a result of the COVID-19 pandemic. The present article provides an overview of how to prepare a wound bed in the community.
Topics: Bandages; COVID-19; Community Health Nursing; Debridement; Humans; Wounds and Injuries
PubMed: 34473537
DOI: 10.12968/bjcn.2021.26.Sup9.S6 -
Journal of Wound Care Jul 2022
Topics: Debridement; Humans
PubMed: 35797251
DOI: 10.12968/jowc.2022.31.Sup7.S3 -
Surgical Infections Jun 2020Removal of hardware with irrigation and debridement in patients with surgical site infections (SSIs) is performed commonly. However, the removal of hardware from... (Review)
Review
Removal of hardware with irrigation and debridement in patients with surgical site infections (SSIs) is performed commonly. However, the removal of hardware from patients with SSIs after spinal procedures is controversial. Moreover, primary spinal infections such as spondylodiscitis may require instrumentation along with surgical debridement. The purpose of this article was to evaluate critically and summarize the available evidence related to retention of hardware in patients with deep SSIs, and the use of instrumentation in surgical treatment of primary spinal infections. A literature search utilizing PubMed database was performed. Studies reporting the management of deep SSIs after instrumented spinal procedures, and of primary spinal infections using instrumentation published in peer-reviewed journals were included. Identified publications were evaluated for relevance, and data were extracted from the studies deemed relevant. Because SSIs occur typically during the early post-operative period before stable bony fusion has been achieved, the removal of instrumentation may be associated with instability of the spinal column, pseudarthrosis, progressive deformity, pain, loss of function, and deterioration in the activities of daily living (ADL). Hence, early SSIs after spinal instrumentation are usually treated without removal of hardware. Moreover, primary spinal infections such as spondylodiscitis may require surgical debridement and instrumentation in cases with associated instability. Retaining or using instrumentation in patients with SSIs after spinal procedures or in patients with primary spinal infections, respectively, are commonly practiced in the field of spine surgery. Further evidence is required for the development of definitive algorithms to guide spine surgeons in decision making regarding the fate of instrumentation in the treatment of spinal infections.
Topics: Activities of Daily Living; Anti-Bacterial Agents; Debridement; Foreign Bodies; Humans; Internal Fixators; Retrospective Studies; Spinal Diseases; Spine; Surgical Wound Infection; Time Factors
PubMed: 31855116
DOI: 10.1089/sur.2019.206 -
Chinese Journal of Traumatology =... Jan 2022Chronic wounds have always been a tough fight in clinical practice, which can not only make patients suffer from pain physically and mentally but also impose a heavy... (Review)
Review
Chronic wounds have always been a tough fight in clinical practice, which can not only make patients suffer from pain physically and mentally but also impose a heavy burden on the society. More than one factor is relevant to each step of the development of chronic wounds. Along with the in-depth research, we have realized that figuring out the pathophysiological mechanism of chronic wounds is the foundation of treatment, while wound infection is the key point concerned. The cause of infection should be identified and prevented promptly once diagnosed. This paper mainly describes the mechanism, diagnosis and therapeutic strategies of chronic wound infection, and will put an emphasis on the principle of debridement.
Topics: Chronic Disease; Debridement; Humans; Wound Infection
PubMed: 34315658
DOI: 10.1016/j.cjtee.2021.07.004