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Journal of Orthopaedic Trauma Aug 2021The video depicts the materials and steps for applying negative pressure wound therapy. The clinical case involves a patient who had sustained a thigh Morel-Lavallee...
The video depicts the materials and steps for applying negative pressure wound therapy. The clinical case involves a patient who had sustained a thigh Morel-Lavallee lesion that developed overlying skin necrosis and drainage that was treated with surgical debridement and the application of negative pressure wound therapy.
Topics: Debridement; Drainage; Humans; Negative-Pressure Wound Therapy; Soft Tissue Injuries
PubMed: 34227602
DOI: 10.1097/BOT.0000000000002183 -
The Journal of Bone and Joint Surgery.... Oct 2023Infection remains a costly, devastating complication following the treatment of open fractures. The appropriate timing of debridement is controversial, and available...
BACKGROUND
Infection remains a costly, devastating complication following the treatment of open fractures. The appropriate timing of debridement is controversial, and available evidence has been conflicting.
METHODS
This study is a retrospective analysis of the SIGN (Surgical Implant Generation Network) Surgical Database (SSDB), a prospective registry of fracture cases in predominantly low-resource settings. Skeletally mature patients (≥16 years of age) who returned for follow-up at any time point after intramedullary nailing of an open femoral or tibial fracture were included. Patients were excluded if they had delays in debridement exceeding 7 days after the injury. Utilizing a model adjusting for potential confounders, including patient demographic characteristics, injury characteristics, country income level, and hospital type and resources, local logistic regression analysis was performed to evaluate the probability of infection with increasing time to debridement in 6-hour increments.
RESULTS
In this study, 27.3% of patients met the eligibility criteria and returned for follow-up, with a total of 10,651 fractures from 61 countries included. Overall, the probability of infection increased by 0.17% for every 6-hour delay in debridement. On subgroup analysis, the probability of infection increased by 0.23% every 6 hours for Gustilo-Anderson type-III injuries compared with 0.13% for Gustilo-Anderson type-I or II injuries. The infection risk increased every 6 hours by 0.18% for tibial fractures compared with 0.13% for femoral fractures.
CONCLUSIONS
There was a linear and cumulative increased risk of infection with delays in debridement for open femoral and tibial fractures. Such injuries should be debrided promptly and expeditiously. The size and international nature of this cohort make these findings uniquely generalizable to nearly all environments where such injuries are treated.
LEVEL OF EVIDENCE
Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
Topics: Humans; Debridement; Retrospective Studies; Tibial Fractures; Fracture Fixation, Internal; Fracture Fixation, Intramedullary; Fractures, Open; Treatment Outcome; Femoral Fractures
PubMed: 37616420
DOI: 10.2106/JBJS.23.00074 -
Journal of Burn Care & Research :... Feb 2020Early recognition of the need for escharotomy and other decompressive therapies is imperative for experienced burn providers, as to avoid reversible tissue ischemia and... (Review)
Review
Early recognition of the need for escharotomy and other decompressive therapies is imperative for experienced burn providers, as to avoid reversible tissue ischemia and necrosis. With full-thickness burns, the eschar that develops is largely noncompliant. The predictable edema that develops during resuscitation of larger burns increases the likelihood ischemia-inducing pressure, as the underlying tissues swell within noncompliant skin, resulting in burn-induced compartment syndrome. Conventionally, this has been treated with decompressive therapies, such as escharotomy. The most recent surveys have identified that the United States and Canada both face a shortage of practicing burn surgeons. In the event of a burn disaster, many nonburn surgeons would need to provide burn care, including decompressive therapies. We reviewed the literature to provide accurate, accessible, and applicable recommendations regarding this practice following burn injury for both the practicing burn surgeon and those that would provide care in the burn disaster.
Topics: Burns; Compartment Syndromes; Debridement; Decompression, Surgical; Fasciotomy; Humans; Resuscitation
PubMed: 31504609
DOI: 10.1093/jbcr/irz152 -
The American Surgeon Nov 2023Necrotizing pancreatitis (NP) may result de novo or following procedures such as ERCP or partial pancreatectomy (post-procedural), and may require surgical debridement....
BACKGROUND
Necrotizing pancreatitis (NP) may result de novo or following procedures such as ERCP or partial pancreatectomy (post-procedural), and may require surgical debridement. Video-assisted retroperitoneal debridement (VARD) is a standard approach for NP that employs a 5 cm incision with varying degrees of blind and open debridement. We describe our technique and outcomes of a modified VARD called laparoscopic-assisted pancreatic necrosectomy (LAPN) performed through a single 12 mm incision that uses direct laparoscopic visualization during debridement.
METHODS
At one medical center, all LAPN patients (2012-2020) were assessed for demographics, disease factors, and outcomes. Bivariate logistic regression analyses were performed to identify factors independently associated with recovery after LAPN for patients with vs post-procedural necrosum.
RESULTS
Over 9 years, 60 patients underwent LAPN for NP. Median age was 57 years (IQR: 47-66) and 43 (69%) were men. Pancreas necrosum was in 39 (63%) patients and post-procedural in 23 (37%). NP resolved with a median of 1 LAPN procedure and median hospitalization was 33 days. The LAPN major morbidity rate and in-hospital mortality rate were 47% and 5%. No significant differences were seen between NP etiology cohorts, although post-procedure NP patients trended towards a faster clinical recovery to baseline compared to patients (193 vs 394 days; -value = .07).
CONCLUSIONS
LAPN offers a smaller incision with excellent visualization and non-inferior outcomes, regardless of etiology, with likely faster recovery for patients with post-procedural vs necrotizing pancreatitis.
Topics: Male; Humans; Middle Aged; Female; Debridement; Pancreas; Laparoscopy; Pancreatitis, Acute Necrotizing; Retroperitoneal Space; Drainage; Treatment Outcome
PubMed: 35575200
DOI: 10.1177/00031348221101495 -
Revue Medicale Suisse Dec 2022Fracture-related infection is a feared complication of trauma surgery with potentially major repercussions on quality of life and healthcare systems. Its management is...
Fracture-related infection is a feared complication of trauma surgery with potentially major repercussions on quality of life and healthcare systems. Its management is based on two pillars: a radical surgical debridement along with a targeted long-term antibiotic therapy based on multiple deep tissue samples obtained during the chosen surgical procedure. Multidisciplinary management and early diagnosis are essential for treatment success. The implementation of a standardized definition for fracture-related infections since 2018 has allowed the optimization and streamlining of management algorithms and their validation in the literature. This article provides a comprehensive and in-depth review of recent advances in the diagnosis and management of fracture-related infections.
Topics: Humans; Fracture Fixation, Internal; Surgical Wound Infection; Debridement; Quality of Life; Fractures, Bone; Anti-Bacterial Agents
PubMed: 36515473
DOI: 10.53738/REVMED.2022.18.808.2363 -
Advances in Skin & Wound Care Apr 2023To enhance the learner's chronic wound debridement competence as an interprofessional team member.
GENERAL PURPOSE
To enhance the learner's chronic wound debridement competence as an interprofessional team member.
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:1. Differentiate healable, maintenance, and nonhealable wounds to create a holistic debridement treatment plan using the Wound Bed Preparation paradigm.2. Evaluate active debridement options including the potential need for an interprofessional referral or specialized investigations.3. Assess chronic wound debridement options.4. Analyze case studies for appropriate clinical application of debridement modalities.
Topics: Humans; Debridement; Wound Healing; Patient Care Planning; Wounds and Injuries
PubMed: 36940374
DOI: 10.1097/01.ASW.0000920660.07232.f7 -
Journal of Wound Care Sep 2022To determine the role of debridement when patients are using placental-derived allografts (PDAs), data from two prospective, multicentre, randomised controlled trials...
OBJECTIVE
To determine the role of debridement when patients are using placental-derived allografts (PDAs), data from two prospective, multicentre, randomised controlled trials (RCTs) were evaluated for the quality or adequacy of debridement on diabetic foot ulcers (DFUs) treated with PDAs. Results were compared with real-world findings via a retrospective analysis of 2015-2019 Medicare claims for DFUs.
METHOD
Debridement adequacy in the prospective RCTs was adjudicated by three blinded wound care specialists. Treatments included two PDAs, dehydrated human amnion/chorion membrane (DHACM, n=54) or dehydrated human umbilical cord (DHUC, n=101), compared with standard of care (SOC, n=110). The key outcome was the influence of adequate debridement on rates of complete closure within 12 weeks. Additionally, a retrospective analysis of 2015-2019 Medicare claims for DFUs that received routine debridement at intervals ranging from every 1-7 days (18,900 total episodes), 8-14 days (35,728 total episodes), and every 15 days or greater (34,330 total episodes) was performed.
RESULTS
Within the RCTs, adequate debridement occurred in 202/265 (76%) of patients, 90/110 (82%) SOC ulcers, 45/54 (83%) of DHACM-treated ulcers, and in 67/101 (66%) of DHUC-treated ulcers. Complete closure occurred in 150/202 (74%) of adequately debrided ulcers, and in only 13/63 (21%) of ulcers without adequate debridement, p<0.0001. Debridement was the most significant factor for closure even when controlling for other clinical characteristics. Within the Medicare claims data 21% (18,900/88,958) of episodes treated with SOC only had debridement intervals of ≤7 days. Short debridement intervals in combination with the use of DHACM demonstrated statistically significant better outcomes than SOC including: 65% fewer major amputations (p<0.0001), higher DFU resolution rates (p=0.0125), 42% fewer emergency room visits (p<0.0001) and reduced usage of other hospital resources (admissions and readmissions).
CONCLUSION
Prospectively collected data examining the quality of debridement and retrospectively analysed data examining the frequency of debridement supports routine adequate wound debridement, particularly at intervals of seven days, as an essential component of wound care. Optimal use of placental-derived allografts improves outcomes and lowers the use of healthcare resources.
Topics: Allografts; Debridement; Diabetes Mellitus; Diabetic Foot; Female; Humans; Randomized Controlled Trials as Topic; Transplantation, Homologous; Wound Healing
PubMed: 36113857
DOI: 10.12968/jowc.2022.31.Sup9.S16 -
Expert Opinion on Biological Therapy 2023Accurate burn depth assessment and early excision of burn eschar with maximal dermal preservation are key concepts in the optimal care of burn injury. Although excision... (Review)
Review
INTRODUCTION
Accurate burn depth assessment and early excision of burn eschar with maximal dermal preservation are key concepts in the optimal care of burn injury. Although excision with knife has long since been standard of care, a newer technique for wound bed preparation utilizing a bromelain-based enzyme has gained popularity worldwide and may offer several advantages.
AREAS COVERED
Here we report the pharmacologic properties, evidence for clinical efficacy, safety, and tolerability of anacaulase-bcdb for the treatment of deep partial thickness and full thickness burns.
EXPERT OPINION
Anacaulase-bcdb is a safe, non-surgical, selective eschar removal agent. It offers advantages over surgical excision of burn with knife and fulfills two unmet needs: burn depth assessment and dermal preservation during excision. Evidence supports a faster time to complete eschar removal; reduced number of operations; reduction in the amount of autografting, length of stay, and blood loss; prevention of burn induced compartment syndrome; and improved cosmetic outcome.
Topics: Humans; Wound Healing; Debridement; Burns; Treatment Outcome; Skin Transplantation
PubMed: 37833828
DOI: 10.1080/14712598.2023.2270903 -
Current Problems in Surgery Jul 2024
Review
Topics: Humans; Fournier Gangrene; Male; Debridement; Patient Care Team; Combined Modality Therapy; Anti-Bacterial Agents
PubMed: 38879239
DOI: 10.1016/j.cpsurg.2024.101499 -
The International Journal of Lower... Sep 2021Maggot therapy, also known as maggot debridement therapy, larval therapy, biodebridement, or biosurgery, is a type of biotherapy involving the intentional application of...
Maggot therapy, also known as maggot debridement therapy, larval therapy, biodebridement, or biosurgery, is a type of biotherapy involving the intentional application of live, disinfected fly larvae or maggots into the nonhealing wound of a human or animal to debride the necrotic wound, reduce bacterial contamination of the wound as well as enhance the formation of healthy granulation tissue and stimulate healing in nonhealing wounds. In addition, van der Plas et al reported that the use of the medicinal larvae as natural remover of necrotic and infected tissue had prevented amputation in 11 selected patients. In Malaysia, Aaron et al had demonstrated prevention of amputation in 25 patients.
Topics: Animals; Debridement; Dermatologic Surgical Procedures; Humans; Larva; Malaysia; Wound Healing
PubMed: 32524879
DOI: 10.1177/1534734620932397