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BMJ Case Reports Oct 2023A woman in her 50s presented with a 4-day history of left knee pain, erythema, swelling as well as malaise and rigours 1 month after undergoing a left knee meniscectomy....
A woman in her 50s presented with a 4-day history of left knee pain, erythema, swelling as well as malaise and rigours 1 month after undergoing a left knee meniscectomy. She was diagnosed with left native knee septic arthritis and underwent arthroscopic irrigation and debridement of the knee; cultures from synovial tissue grew spp are soil-dwelling and livestock-dwelling bacteria which occasionally cause disease in immunocompromised hosts. Infection in immunocompetent hosts is rare, and septic arthritis secondary to has not been reported previously.
Topics: Female; Humans; Debridement; Arthroscopy; Rhodococcus; Arthritis, Infectious
PubMed: 37802590
DOI: 10.1136/bcr-2023-256864 -
Advances in Skin & Wound Care Feb 2024Wound debridement improves healing in a variety of acute and chronic ulcers. However, there is concern that debridement may trigger pathergy and worsen pyoderma...
BACKGROUND
Wound debridement improves healing in a variety of acute and chronic ulcers. However, there is concern that debridement may trigger pathergy and worsen pyoderma gangrenosum (PG).
OBJECTIVE
To determine whether published evidence supports conservative wound debridement for PG.
DATA SOURCES
The authors reviewed the literature published in MEDLINE through January 2023 using the search germs "pyoderma gangrenosum" and "debridement."
STUDY SELECTION
Articles reporting sharp surgical debridement or maggot debridement for PG were included in the review. The authors also searched the reference sections of the reviewed articles for additional reports on debridement for PG.
DATA EXTRACTION
Clinical data regarding patient status, procedures performed, and patient outcomes were extracted from the selected articles.
DATA SYNTHESIS
There are multiple reports of uncontrolled, active-phase PG wounds worsening after aggressive excisional debridement of viable inflamed tissues. In contrast, there is no evidence indicating that conservative debridement of nonviable necrotic tissue worsens PG wounds, regardless of the disease activity. There are multiple reports of successful debridement and surgical grafting for PG in remission.
CONCLUSIONS
There is no evidence in favor of or against using conservative debridement of nonviable necrotic tissue for a PG wound. Therefore, it should not be considered contraindicated, even in the active phase of the disease.
Topics: Animals; Humans; Debridement; Pyoderma Gangrenosum; Wound Healing; Larva; Necrosis
PubMed: 38241454
DOI: 10.1097/ASW.0000000000000092 -
Wounds : a Compendium of Clinical... Dec 2022Management of VLUs can be challenging, depending on wound complexity, and may require the use of several treatment modalities to achieve complete wound closure or... (Review)
Review
Management of VLUs can be challenging, depending on wound complexity, and may require the use of several treatment modalities to achieve complete wound closure or significant wound area reduction. This review presents a systematic approach to management of VLUs based on previous literature and the authors' clinical experience, with consideration given to wound size, etiology, and responses to prior treatment. Techniques described include debridement (autolytic, enzymatic, sharp/surgical), compression therapy, physical therapy, medical adjuncts, and cellular- and tissue-based therapy. The algorithm of care for VLUs is multimodal. Appropriate diagnostic studies must be performed, including venous duplex and appropriate pathophysiology to confirm the diagnosis of VLU. After the correct diagnosis is confirmed, appropriate treatment may commence. All patients should undergo appropriate wound debridement; the exact modality used is dependent on wound characteristics. Patients must also adhere to consistent compression therapy. Any underlying venous disease that is amenable to surgical intervention should be addressed. Treatment with a medical adjunct and physical therapy are recommended. For patients who do not achieve significant wound area reduction, the addition of CTP is recommended. Use of these methods should result in substantial wound area reduction and/or wound closure.
Topics: Humans; Compression Bandages; Wound Healing; Varicose Ulcer; Debridement; Treatment Outcome; Leg Ulcer
PubMed: 36622379
DOI: 10.25270/wnds/21160 -
Journal of Wound Care Jun 2024
Topics: Humans; Debridement; Wounds and Injuries; Wound Healing
PubMed: 38829182
DOI: 10.12968/jowc.2024.33.Sup6b.S1 -
The Cochrane Database of Systematic... May 2024Surgical wounds that become infected are often debrided because clinicians believe that removal of this necrotic or infected tissue may expedite wound healing. There are... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Surgical wounds that become infected are often debrided because clinicians believe that removal of this necrotic or infected tissue may expedite wound healing. There are numerous methods of debridement available, but no consensus on which one is most effective for surgical wounds.
OBJECTIVES
To assess the effects of different methods of debridement on the rate of debridement and healing of surgical wounds.
SEARCH METHODS
In October 2021, we searched the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL. To identify additional studies, we searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies, reviews, meta-analyses, and health technology reports. There were no restrictions on language, date of publication, or study setting.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) that enrolled people with a surgical wound that required debridement, and reported time to complete wound debridement or time to wound healing, or both.
DATA COLLECTION AND ANALYSIS
Two review authors independently performed study selection, risk of bias assessment using the RoB 1 tool, data extraction, and GRADE assessment of the certainty of evidence.
MAIN RESULTS
In this fourth update, we identified one additional study for inclusion. The review now includes six studies, with 265 participants, aged three to 91 years. Five studies were published between 1979 and 1990 and one published in 2014. The studies were carried out in hospital settings in China, Denmark, Belgium, and the UK. Six studies provided six comparisons. Due to the heterogeneity of studies, it was not appropriate to conduct meta-analyses. Four studies evaluated the effectiveness of dextranomer beads/paste; however, each study used a different comparator (Eusol-soaked dressings, 10% aqueous polyvinylpyrrolidone, 0.1% chloramine-soaked packs, and silicone foam elastomer dressing). One study compared streptokinase/streptodornase with saline-soaked dressings, and one compared endoscopic surgical debridement with conventional 'open' surgical debridement. Five studies reported time to complete debridement (reported as time to a clean wound bed) and three reported time to complete healing. One study reported effect estimates (surgical debridement via endoscopy versus surgical debridement) for time to a clean wound bed and time to complete wound healing, and it was possible to calculate effect estimates for one other study (dextranomer paste versus silicone foam elastomer) for time to complete wound healing. For the other four studies that did not report effect estimates, it was not possible to calculate time to a clean wound bed or time to complete wound healing due to missing variance and participant exclusions. None of the included studies reported outcomes pertaining to proportion of wounds completely healed, rate of reduction in wound size, rate of infection, or quality of life. All studies had unclear or high risk of bias for at least one key domain. Dextranomer paste/beads (autolytic debridement) compared with four different comparators Four studies compared dextranomer paste or beads with Eusol-soaked gauze (20 participants), 10% aqueous polyvinylpyrrolidone (40 participants), 0.1% chloramine-soaked dressings (28 participants), or silicone foam elastomer (50 participants). There is very low-certainty evidence that there may be no clear difference in time to a clean wound bed between dextranomer beads and Eusol gauze. The study did not report adverse events. There is very low-certainty evidence that there may be no difference in time to a clean wound bed between dextranomer paste and 10% aqueous polyvinylpyrrolidone gauze. There was low-certainty evidence that there may be no difference in deaths and serious adverse events. There may be a difference in time until the wounds were clinically clean and time to complete wound healing between dextranomer paste and 0.1% chloramine favouring 0.1% chloramine, but we are very uncertain. There is low-certainty evidence that there may be no difference in deaths and serious adverse events. There is very low-certainty evidence that there may be no difference in time to complete healing between dextranomer beads and silicone foam elastomer. The study did not report adverse events. Streptokinase/streptodornase solution (enzymatic) compared with saline-soaked dressings One study (21 participants) compared enzymatic debridement with saline-soaked dressings. There is low-certainty evidence that there may be no difference in time to a clean wound bed or secondary suture between streptokinase/streptodornase and saline-soaked dressings. There is very low-certainty evidence that there may be no difference in deaths and serious adverse events. Surgical debridement via endoscopic ('keyhole') surgery compared with surgical debridement by 'open' surgery (the wound is opened using a scalpel) One study (106 participants) reported time to complete wound healing and time to a clean wound bed. There is low-certainty evidence that there may be a reduction in time to complete wound healing and very low-certainty evidence that there may be no difference in time to a clean wound bed with surgical debridement via endoscopy compared to 'open' surgical debridement. The study did not report adverse events. Overall, the evidence was low to very low-certainty for all outcomes. Five included studies were published before 1991 and investigated treatments that are no longer available. Worldwide production of dextranomer products has been discontinued, except for dextranomer paste, which is currently only available in South Africa. Furthermore, Eusol, used in one study as the comparator to dextranomer, is rarely used due to risk of harmful effects on healthy tissue and the enzymatic agent streptokinase/streptodornase is no longer available worldwide.
AUTHORS' CONCLUSIONS
Evidence for the effects of different methods of debridement on complete wound debridement and healing of surgical wounds remains unclear. Adequately powered, methodologically robust RCTs evaluating contemporary debridement interventions for surgical wounds are needed to guide clinical decision-making.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Humans; Middle Aged; Young Adult; Bandages; Bias; Debridement; Randomized Controlled Trials as Topic; Surgical Wound; Surgical Wound Infection; Time Factors; Wound Healing
PubMed: 38712723
DOI: 10.1002/14651858.CD006214.pub5 -
Foot and Ankle Surgery : Official... Jul 2022This systematic review investigated the outcomes of revision surgery after periprosthetic ankle infection (PAI). (Review)
Review
BACKGROUND
This systematic review investigated the outcomes of revision surgery after periprosthetic ankle infection (PAI).
METHODS
According to the PRISMA statement, 9 studies with 131 PAIs surgically treated and analyzed were included. Demographics and surgical techniques with eradication rates and complications were reported.
RESULTS
Methicillin-sensitive Staphylococcus aureus (MSSA) (30.4%) and coagulase-negative Staphylococcus (CNS) (26.5%) were the most common microorganisms. The eradication rate was 91.7% with permanent antibiotic spacers (SPC), 84.4% with 2-stage, 79.4% with arthrodesis (AA), and 58.8% with debridement and implant retention (DAIR). DAIR showed a significantly lower eradication rate than 2-stage (p = 0.016) and SPC (p = 0.043). Amputations occurred in 25% of patients after SPC, 8.8% after AA and 3.9% after DAIR. SPC showed a significantly higher amputation rate than DAIR and 2-stage (p = 0.044, and p = 0.017, respectively).
CONCLUSIONS
SPC and 2-stage revision show the highest eradication rates, but 2-stage has a lower risk of amputation.
Topics: Ankle; Anti-Bacterial Agents; Debridement; Humans; Limb Salvage; Prosthesis-Related Infections; Retrospective Studies; Treatment Outcome
PubMed: 34321185
DOI: 10.1016/j.fas.2021.07.009 -
Advances in Skin & Wound Care Oct 2020To present an overview of the advantages of maggot debridement therapy as a treatment for chronic wounds through the review of several larval properties. (Review)
Review
GENERAL PURPOSE
To present an overview of the advantages of maggot debridement therapy as a treatment for chronic wounds through the review of several larval properties.
TARGET AUDIENCE
This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.
LEARNING OBJECTIVES/OUTCOMES
After participating in this educational activity, the participant will be able to:1. Summarize the use, process, and precautions for maggot debridement to treat chronic wounds.2. Synthesize the results of the bibliographic review of the use of maggot debridement to treat chronic wounds.
ABSTRACT
Maggot debridement therapy (MDT) is effective for ulcer debridement, achieving it in less time than other therapies. It offers a benefit to healing. However, it is unclear whether maggots reduce treatment time and there is considerable controversy around the treatment's potential antimicrobial action and cost-effectiveness. Nevertheless, it can be effective in preventing amputations and reducing the need for systemic antibiotics. This bibliographic review assesses the advantages of MDT as a treatment for chronic wounds through the review of several larval properties. The review was carried out by consulting biomedical databases including CINAHL, MEDLINE (PubMed), and Scopus, and concludes that MDT is an effective debridement and potential technique to facilitate healing. However, more data is needed on the wound type application frequency and the efficacy of treatment.
Topics: Animals; Debridement; Diabetic Foot; Foot Ulcer; Humans; Larva; Wound Healing; Wounds and Injuries
PubMed: 32941225
DOI: 10.1097/01.ASW.0000695776.26946.68 -
Journal of Shoulder and Elbow Surgery Aug 2022Open débridement and Outerbridge-Kashiwagi (OK) débridement arthroplasty (OK procedure) are common surgical treatments for elbow arthritis, but little is known about...
BACKGROUND
Open débridement and Outerbridge-Kashiwagi (OK) débridement arthroplasty (OK procedure) are common surgical treatments for elbow arthritis, but little is known about their long-term survivorship. The purpose of this study was to determine whether survivorship until conversion to total elbow replacement and revision surgery was better for the OK procedure compared with open débridement.
METHODS
We performed a retrospective chart review of patients who underwent open elbow surgical débridement (open débridement or OK procedure) between 2000 and 2015. Patients received a diagnosis of primary elbow osteoarthritis, post-traumatic arthritis, or inflammatory arthritis. A total of 320 patients underwent surgery including open débridement (n = 142) or the OK procedure (n = 178), and of these patients, 33 required secondary revision surgery (open débridement, n = 14; OK procedure, n = 19). The average time since surgery was 11.5 years (range, 5.5-21.5 years). Survivorship was analyzed with Kaplan-Meier curves and the log rank test. A Cox proportional hazards model was used to estimate the effect of the type of procedure, index diagnosis, age, and sex on survivorship.
RESULTS
Kaplan-Meier survival curves showed survivorship rates until total elbow arthroplasty of 100.0% at 1 year, 99.3% at 5 years, and 98.5% at 10 years for open débridement and 100.0% at 1 year, 98.8% at 5 years, and 98.0% at 10 years for the OK procedure (P = .87). There was no difference in survivorship between procedures, even after adjustment for significant covariates. The rates of revision for open débridement and the OK procedure were similar, at 11.3% and 11.5%, respectively, after 10 years. Higher rates of revision surgery were observed in patients who underwent open débridement (hazard ratio, 4.84; 95% confidence interval, 1.29-18.17; P = .019) compared with those who underwent the OK procedure after adjustment for covariates. We performed a stratified analysis with radiographic severity as an effect modifier and showed that patients with grade 3 arthritis fared better after the OK procedure compared with open débridement in terms of survivorship until revision surgery (P = .05). However, such a difference was not found for grade 1 or grade 2 arthritis.
CONCLUSION
We showed that both open elbow débridement and the OK procedure had excellent survivorship until conversion to total elbow arthroplasty and are viable options in the treatment of primary elbow osteoarthritis and post-traumatic cases that could help delay the need for total elbow arthroplasty. Patients with more severe radiographic arthritis, specifically grade 3 arthritis, were less likely to require revision surgery if treated initially with the OK procedure compared with open débridement.
Topics: Arthroplasty, Replacement, Elbow; Debridement; Elbow; Humans; Osteoarthritis; Reoperation; Retrospective Studies; Survivorship; Treatment Outcome
PubMed: 35189372
DOI: 10.1016/j.jse.2022.01.138 -
BMC Surgery Jul 2023Vacuum sealing drainage (VSD) is widely applied in complex wound repair. We aimed to compare traditional debridement and drainage and VSD in treating Fournier's gangrene...
BACKGROUND
Vacuum sealing drainage (VSD) is widely applied in complex wound repair. We aimed to compare traditional debridement and drainage and VSD in treating Fournier's gangrene (FG).
METHODS
Data of patients surgically treated for FG were retrospectively analyzed.
RESULTS
Of the 36 patients (men: 31, women: 5; mean age: 53.5 ± 11.3 [range: 28-74] years) included in the study, no patients died. Between-group differences regarding sex, age, BMI, time from first debridement to wound healing, number of debridements, FGSI, and shock were not statistically significant (P > 0.05). However, lesion diameter, colostomy, VAS score, dressing changes, analgesic use, length of hospital stay, and wound reconstruction method (χ = 5.43, P = 0.04) exhibited statistically significant differences. Tension-relieving sutures (6 vs. 21) and flap transfer (4 vs. 2) were applied in Groups I and II, respectively.
CONCLUSION
VSD can reduce postoperative dressing changes and analgesic use, and shrunk the wound area, thereby reducing flap transfer in wound reconstruction.
Topics: Male; Humans; Female; Adult; Middle Aged; Fournier Gangrene; Negative-Pressure Wound Therapy; Retrospective Studies; Debridement; Drainage
PubMed: 37496026
DOI: 10.1186/s12893-023-02109-0 -
British Dental Journal May 2024As utilisation of dental implants continues to rise, so does the incidence of biological complications. When peri-implantitis has already caused extensive bone... (Review)
Review
As utilisation of dental implants continues to rise, so does the incidence of biological complications. When peri-implantitis has already caused extensive bone resorption, the dentist faces the dilemma of which therapy is the most appropriate to maintain the implant. Since non-surgical approaches of peri-implantitis have shown limited effectiveness, the present paper describes different surgical treatment modalities, underlining their indications and limitations. The primary goal in the management of peri-implantitis is to decontaminate the surface of the infected implant and to eliminate deep peri-implant pockets. For this purpose, access flap debridement, with or without resective procedures, has shown to be effective in a large number of cases. These surgical treatments, however, may be linked to post-operative recession of the mucosal margin. In addition to disease resolution, reconstructive approaches also seek to regenerate the bone defect and to achieve re-osseointegration.
Topics: Humans; Peri-Implantitis; Surgical Flaps; Dental Implants; Debridement
PubMed: 38789758
DOI: 10.1038/s41415-024-7405-9