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Journal of Burn Care & Research :... Mar 2024Since 1970 surgeons have managed deep burns by surgical debridement and autografting. We tested the hypothesis that enzymatic debridement with NexoBrid would remove the... (Randomized Controlled Trial)
Randomized Controlled Trial
Since 1970 surgeons have managed deep burns by surgical debridement and autografting. We tested the hypothesis that enzymatic debridement with NexoBrid would remove the eschar reducing surgery and achieve comparable long-term outcomes as standard of care (SOC). In this Phase 3 trial, we randomly assigned adults with deep burns (covering 3-30% of total body surface area [TBSA]) to NexoBrid, surgical or nonsurgical SOC, or placebo Gel Vehicle (GV) in a 3:3:1 ratio. The primary endpoint was complete eschar removal (ER) at the end of the debridement phase. Secondary outcomes were need for surgery, time to complete ER, and blood loss. Safety endpoints included wound closure and 12 and 24-months cosmesis on the Modified Vancouver Scar Scale. Patients were randomized to NexoBrid (n = 75), SOC (n = 75), and GV (n = 25). Complete ER was higher in the NexoBrid versus the GV group (93% vs 4%; P < .001). Surgical excision was lower in the NexoBrid vs the SOC group (4% vs 72%; P < .001). Median time to ER was 1.0 and 3.8 days for the NexoBrid and SOC respectively (P < .001). ER blood loss was lower in the NexoBrid than the SOC group (14 ± 512 mL vs 814 ± 1020 mL, respectively; P < .0001). MVSS scores at 12 and 24 months were noninferior in the NexoBrid versus SOC groups (3.7 ± 2.1 vs 5.0 ± 3.1 for the 12 months and 3.04 ± 2.2 vs 3.30 ± 2.76 for the 24 months). NexoBrid resulted in early complete ER in >90% of burn patients, reduced surgery and blood loss. NexoBrid was safe and well tolerated without deleterious effects on wound closure and scarring.
Topics: Adult; Humans; Burns; Cicatrix; Debridement; Wound Healing
PubMed: 37715999
DOI: 10.1093/jbcr/irad142 -
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 -
Journal of Wound Care Aug 2019To determine the clinical effect and consequential levels of health professionals and patient satisfaction with the results of debridement episodes of wounds with...
OBJECTIVE
To determine the clinical effect and consequential levels of health professionals and patient satisfaction with the results of debridement episodes of wounds with visible slough and/or scaly skin using monofilament fibre debridement technology.
METHODS
This was a non-comparative, open label evaluation conducted in static/non-healing acute and chronic wounds with visible slough and/or scaly skin that required debridement. Monofilament fibre debridement technology was applied in 1-2 sequential treatment episodes during normal clinical practice which followed local practice, guidelines or formularies. Following the clinical phase of the evaluation, health professionals were invited to complete an online survey of the clinical outcomes and their satisfaction with them.
RESULTS
Survey questions were answered by 1129 health professionals. Wounds managed using the monofilament fibre debridement technology during this evaluation included leg ulcers (63%), pressure ulcers (10%), dehisced surgical wounds (3%), diabetic foot ulcers (8%) and other wounds (13%). 'Other' wound types included acute dirty wounds, burns, cellulitis, psoriasis, diabetic amputation wounds, dry flaky skin, moisture wounds, trauma, varicose eczema. Of the wounds, 12% were reported as non-static. There was visible change in the wound and/or skin after first use of the monofilament fibre debridement technology in a high proportion of all wound types, and a further increase in the proportion of wounds with visible change after the second use. The visible difference was significant for both static and non-static wounds. User and patient satisfaction with all clinical outcomes were high, whether or not the user and patient had previous experience of monofilament fibre debridement technology.
CONCLUSION
Monofilament fibre debridement technology provides rapid, visible and effective debridement of slough and scaly skin after one application and further visible improvement after two applications in static and non-static wounds. Health professionals and patients report high levels of satisfaction with outcomes following application of the monofilament fibre debridement technology.
Topics: Debridement; Equipment Design; Humans; Practice Patterns, Physicians'; Pressure Ulcer; Surveys and Questionnaires; Treatment Outcome; United Kingdom; Wound Healing
PubMed: 31393801
DOI: 10.12968/jowc.2019.28.8.534 -
Journal of Wound Care Jul 2022Vulvar necrotising fasciitis (VNF) is a severe soft tissue infection associated with substantial morbidity and high mortality. At Stony Brook Medicine, US, patients with... (Review)
Review
OBJECTIVE
Vulvar necrotising fasciitis (VNF) is a severe soft tissue infection associated with substantial morbidity and high mortality. At Stony Brook Medicine, US, patients with known or suspected VNF are treated by a structured multidisciplinary team consisting of members of the Departments of Emergency Medicine and Medicine, the Divisions of Gynecologic Oncology, Burn and Surgical Intensive Care Units, Infectious Disease and Plastic Surgery, and the nursing, nutrition, physical/occupational therapy and social work services.
METHOD
This is a retrospective review of patients presenting to Stony Brook University Hospital with VNF over an 18-month period.
RESULTS
A total of 10 patients were treated for VNF during the study period. All patients were treated by the structured multidisciplinary team, including extensive initial surgical debridement by the gynaecologic oncologists. All patients survived to discharge.
CONCLUSION
The results of this review demonstrated that prompt diagnosis, rapid implementation of appropriate antibiotic coverage, surgical debridement of necrotic tissue, and comprehensive care delivered by a structured multidisciplinary team contributed to positive clinical outcomes and decreased the risk of death from VNF.
Topics: Debridement; Fasciitis, Necrotizing; Female; Humans; Plastic Surgery Procedures; Retrospective Studies; Soft Tissue Infections; Treatment Outcome
PubMed: 35797247
DOI: 10.12968/jowc.2022.31.Sup7.S20 -
The Permanente Journal May 2021Nasal/sinus endoscopy with biopsy/polypectomy/debridement, or Current Procedure Terminology code 31237, is one of the top 10 most frequent and highest billed...
INTRODUCTION
Nasal/sinus endoscopy with biopsy/polypectomy/debridement, or Current Procedure Terminology code 31237, is one of the top 10 most frequent and highest billed otolaryngology procedures among Medicare patients. We analyzed temporal and geographic trends in endoscopic debridement, and correlated them with sinus surgery and balloon sinuplasty trends.
METHODS
Medicare Part-B National Summary Data Files were analyzed from 2000 to 2016 for temporal trends of endoscopic debridement. Medicare Physician and Other Supplier Public Use Files detailing provider information were collected and analyzed from 2012 to 2016. Individual providers performing a reportable number of procedures were included. Linear regression was used to correlate endoscopic debridement, sinus surgery, and balloon sinuplasty procedures.
RESULTS
Between 2000 and 2016, the number of endoscopic debridement procedures increased from 31,579 to 79,762 (6.0% average annual growth). The annual total payments increased from $5,944,582 to $19,438,956 (8.4% average annual growth), with average allowed charge per procedure increasing from $188.24 to $243.71. The greatest and least number of debridement procedures occurred in the Southeast (12,703) and New England (1810) regions, respectively. There was a positive correlation between providers (n = 752) performing endoscopic debridement and sinus surgery (r = 0.31, p < 0.001), which was similar to providers performing endoscopic debridement and balloon sinuplasty (r = 0.29, P < 0.001).
CONCLUSION
Otolaryngologists continue to perform increasing numbers of endoscopic debridements and receive increasing payments. There is some geographic variation in these trends. Among individual providers, there was a positive correlation between the number of endoscopic debridement procedures and both the number of balloon sinuplasty and sinus surgery procedures.
Topics: Aged; Debridement; Endoscopy; Humans; Medicare; Otolaryngologists; Paranasal Sinuses; United States
PubMed: 33970073
DOI: 10.7812/TPP/20.110 -
Cornea Jul 2021To describe the management and outcome of an ocular surface alkali burn in the setting of previous laser in situ keratomileusis (LASIK). (Review)
Review
PURPOSE
To describe the management and outcome of an ocular surface alkali burn in the setting of previous laser in situ keratomileusis (LASIK).
METHODS
This is a case report and review of relevant literature.
RESULTS
A 25-year-old man with a history of LASIK presented 4 weeks after a sodium hydroxide splash to his left eye with visual acuity of 20/60 and a nonhealing epithelial defect adjacent to sectoral inferior limbal ischemia in the setting of trichiasis from upper eyelid cicatricial entropion. After topical corticosteroids were discontinued following the repair of the entropion, the patient returned 3 days later with worsening vision and severe diffuse lamellar keratitis with the melting of the LASIK flap. After promptly lifting the flap and debriding the interface, inflammation was managed with oral, instead of topical, corticosteroids. Over several weeks, the epithelium healed, and inflammation and interface edema resolved. At 10 years of follow-up, the patient had developed a localized pseudopterygium with mild corneal neovascularization but maintained 20/20 uncorrected visual acuity.
CONCLUSIONS
A chemical burn over a LASIK flap poses a challenge for managing corticosteroids, which are required to prevent diffuse lamellar keratitis but can also contribute to keratolysis beyond the first week after an alkali injury. Oral corticosteroid therapy may be beneficial in this situation, with a low threshold to lift the LASIK flap and debride the interface if inflammation occurs.
Topics: Adult; Burns, Chemical; Caustics; Corneal Diseases; Debridement; Eye Burns; Glucocorticoids; Humans; Keratomileusis, Laser In Situ; Male; Sodium Hydroxide; Surgical Flaps; Visual Acuity
PubMed: 33273190
DOI: 10.1097/ICO.0000000000002604 -
Nursing Mar 2024Debridement is a core component of chronic wound management. Although various debridement methods exist, each carries a unique patient risk level. This article discusses...
Debridement is a core component of chronic wound management. Although various debridement methods exist, each carries a unique patient risk level. This article discusses the different normal tissue components that are critical to safe debridement practice, various methods of wound debridement for nurses, and the importance of an interprofessional team and consulting a wound specialist.
Topics: Humans; Debridement
PubMed: 38386448
DOI: 10.1097/01.NURSE.0001006292.75909.7f -
Foot and Ankle Clinics Sep 2019Minimally invasive treatment can offer an earlier recovery with less pain and scarring compared with traditional open surgeries. The goals of minimally invasive surgery... (Review)
Review
Minimally invasive treatment can offer an earlier recovery with less pain and scarring compared with traditional open surgeries. The goals of minimally invasive surgery are to debride degenerative tendon, stimulate healing, and, when appropriate, repair damaged tendon. Sclerotherapy and prolotherapy have been shown to reduce neovascularization and pain. Percutaneous stripping and endoscopic debridement are better options for diffuse tendinopathy. Plantaris release can be useful in diffuse disease in patients with primarily medial-sided Achilles pain. Overall, minimally invasive surgery provides similar benefits as open procedures with reduced complications and morbidity.
Topics: Achilles Tendon; Debridement; Endoscopy; Humans; Minimally Invasive Surgical Procedures; Sclerosing Solutions; Tendinopathy; Tenotomy
PubMed: 31370999
DOI: 10.1016/j.fcl.2019.04.007 -
Veterinary Dermatology Oct 2022Management of wounds is a commonly performed and essential aspect of small animal veterinary medicine. Appropriate wound management is a difficult art to master, due to... (Review)
Review
Management of wounds is a commonly performed and essential aspect of small animal veterinary medicine. Appropriate wound management is a difficult art to master, due to the inherent complexity of the clinical scenario, as well as the ever-evolving nature of the field with the constant addition of new products and techniques. This article reviews key concepts that may help the practitioner better understand the natural process of wound healing, factors that delay healing and strategies to help improve the local wound environment to make it more conducive to healing during open wound management. The concept of wound bed preparation is defined before common local wound management strategies, such as wound lavage and debridement, are discussed in more detail. Key aspects of the management of biofilms and appropriate use of antimicrobial agents are also reviewed. Finally, the concept of moist wound healing and its impact in modern wound management is explained before a broad variety of types of wound dressings are reviewed, with a particular focus on active dressings.
Topics: Animals; Anti-Infective Agents; Bandages; Biofilms; Debridement; Wound Healing; Wounds and Injuries
PubMed: 35876262
DOI: 10.1111/vde.13104 -
Wounds : a Compendium of Clinical... Dec 2019Early surgical debridement of nonviable tissue within 48 hours of burn injury is the standard of care (SOC) for burns extending into and beyond the deep dermis. Early...
Early surgical debridement of nonviable tissue within 48 hours of burn injury is the standard of care (SOC) for burns extending into and beyond the deep dermis. Early debridement has been reported to reduce infection and complication rates, shorten hospital stays, and improve burn wound healing compared with delayed debridement of these burns.1 However, surgical debridement challenges patients with considerable pain, blood and heat loss, and poor differentiation between viable and dead tissue resulting in unnecessary excision of healthy tissue.2 Alternative debridement interventions, such as larval, enzymatic, hydrosurgical, or autolytic, have improved outcomes of chronic necrotic wounds3,4 and may offer ways to spare healthy tissue and minimize the recognized challenges of surgical debridement in patients with deep dermal or full-thickness burns. This installment of Evidence Corner reviews recent research exploring hydrosurgical5 or bromelain-based enzyme6 interventions reported to improve burn debridement or repair beyond the current SOC.
Topics: Bromelains; Burns; Cicatrix; Debridement; Evidence-Based Medicine; Guidelines as Topic; Humans; Skin Transplantation; Wound Healing
PubMed: 31833838
DOI: No ID Found