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Burns : Journal of the International... Sep 2023Bromelain-based enzymatic debridement has emerged as a valuable option to the standard surgical intervention for debridement in burn injuries. Adverse effects on...
OBJECTIVES
Bromelain-based enzymatic debridement has emerged as a valuable option to the standard surgical intervention for debridement in burn injuries. Adverse effects on coagulation parameters after enzymatic debridement have been described. The purpose of this study was to compare the effect of enzymatic and surgical debridement on coagulation.
METHODS
Between 03/2017 and 02/2021 patients with burn injuries with a total body surface area (TBSA) ≥ 1% were included in the study. Patients were categorized into two groups: the surgically debrided group and the enzymatically debrided group. Coagulation parameters were assessed daily for the first seven days of hospitalization.
RESULTS
In total 132 patients with a mean TBSA of 17% were included in this study, of which 66 received enzymatic debridement and 66 received regular surgical-debridement. Patients receiving enzymatic debridement presented significantly higher factor-V concentration values over the first seven days after admission (p = <0.01). Regarding coagulation parameters, we found no difference in INR-, aPTT-, fibrinogen-, factor-XIII- and thrombocyte-concentrations over the first seven days (p = >0.05).
CONCLUSION
Enzymatic debridement in burned patients does not appear to increase the risk of coagulation abnormalities compared with the regular surgical approach.
Topics: Humans; Burns; Debridement; Blood Coagulation Disorders; Bromelains; Skin Transplantation
PubMed: 36566096
DOI: 10.1016/j.burns.2022.11.008 -
Hand (New York, N.Y.) Jul 2023Organism identification and their antibiotic sensitivity profile are critical for the successful treatment of upper extremity infections. Although many infections...
BACKGROUND
Organism identification and their antibiotic sensitivity profile are critical for the successful treatment of upper extremity infections. Although many infections resolve with antibiotics alone, some require 1 or more surgical procedures in which culture data are obtained. The purpose of this study was to determine whether repeat cultures taken at subsequent irrigation and debridement of upper extremity infections changed antibiotic treatment.
METHODS
A retrospective review was performed using International Classification of Diseases, Ninth Revision codes to identify all adult patients with an upper extremity infection treated with 2 irrigation and debridement procedures with 2 separate culture data sets over a period of 5 years. Culture organisms and antibiotic sensitivity profiles were compared from each procedure, and changes in antibiotic treatment based on repeat culture information were identified.
RESULTS
In all, 183 patients who underwent 2 irrigation and debridement procedures with repeat culture data were identified. Organisms identified with repeat culture were the same or there was no growth in 153 patients and were different in 30 patients. The antibiotic treatment did not require a change in 170 (92.9%) of 183 patients. Of the 30 patients with different repeat cultures, antibiotic treatment changed in only 13 patients (43.3%). Patients who had a change in antibiotic treatment were more likely to have hepatitis C ( = .005).
CONCLUSIONS
Repeat culture data changed antibiotic treatment in only 7.1% of patients from our cohort. Patients with hepatitis C were more likely to require a change in antibiotic management after obtaining repeat cultures.
Topics: Adult; Humans; Debridement; Anti-Bacterial Agents; Retrospective Studies; Upper Extremity; Hepatitis C
PubMed: 35043710
DOI: 10.1177/15589447211068183 -
European Journal of Medical Research Apr 2023The bubbling community of microorganisms, consisting of diverse colonies encased in a self-produced protective matrix and playing an essential role in the persistence of... (Review)
Review
The bubbling community of microorganisms, consisting of diverse colonies encased in a self-produced protective matrix and playing an essential role in the persistence of infection and antimicrobial resistance, is often referred to as a biofilm. Although apparently indolent, the biofilm involves not only inanimate surfaces but also living tissue, making it truly ubiquitous. The mechanism of biofilm formation, its growth, and the development of resistance are ever-intriguing subjects and are yet to be completely deciphered. Although an abundance of studies in recent years has focused on the various ways to create potential anti-biofilm and antimicrobial therapeutics, a dearth of a clear standard of clinical practice remains, and therefore, there is essentially a need for translating laboratory research to novel bedside anti-biofilm strategies that can provide a better clinical outcome. Of significance, biofilm is responsible for faulty wound healing and wound chronicity. The experimental studies report the prevalence of biofilm in chronic wounds anywhere between 20 and 100%, which makes it a topic of significant concern in wound healing. The ongoing scientific endeavor to comprehensively understand the mechanism of biofilm interaction with wounds and generate standardized anti-biofilm measures which are reproducible in the clinical setting is the challenge of the hour. In this context of "more needs to be done", we aim to explore various effective and clinically meaningful methods currently available for biofilm management and how these tools can be translated into safe clinical practice.
Topics: Humans; Debridement; Wound Infection; Wound Healing; Anti-Infective Agents; Biofilms
PubMed: 37098583
DOI: 10.1186/s40001-023-01121-7 -
Journal of Wound Care Aug 2022Case studies are presented here by a tissue viability nurse consultant and an advanced podiatrist demonstrating the use of ChloraSolv in clinical practice. The first set...
Case studies are presented here by a tissue viability nurse consultant and an advanced podiatrist demonstrating the use of ChloraSolv in clinical practice. The first set of cases is from a community setting, where the tissue viability nurse and district nurse successfully used the product to fully debride hard-to-heal leg ulcers in patients who mostly had been unable to tolerate other forms of debridement. The second set illustrates its use in a podiatry clinic, where the gel removed dry, adherent slough. 'These case studies show that ChloraSolv can be used by any health professional to achieve a clean wound bed'.
Topics: Debridement; Humans; Leg Ulcer; Wound Healing
PubMed: 35994431
DOI: 10.12968/jowc.2022.31.Sup8a.S12 -
Foot and Ankle Clinics Sep 2019Insertional Achilles tendinopathy is one of the most common Achilles tendon disorders and often results in substantial heel pain and functional disability. There is... (Review)
Review
Insertional Achilles tendinopathy is one of the most common Achilles tendon disorders and often results in substantial heel pain and functional disability. There is consensus that treatment of insertional Achilles tendinopathy should start with nonoperative modalities. Surgery should be reserved for patients who fail exhaustive conservative treatment for a period of 3 months to 6 months and include débridement of insertional calcifications. Intratendinous degenerative tissue should be débrided and any Haglund deformity resected. Different surgical techniques have been described for reattachment of the distal Achilles tendon. The authors' preferred surgical technique includes the knotless double-row footprint reconstruction. Postoperative complications are not rare.
Topics: Achilles Tendon; Calcaneus; Debridement; Foot Deformities; Humans; Postoperative Complications; Plastic Surgery Procedures; Tendinopathy
PubMed: 31371002
DOI: 10.1016/j.fcl.2019.04.005 -
Klinische Monatsblatter Fur... Feb 2022To evaluate the clinical outcomes of patients who underwent corneal surgery with debridement of epithelium by localised application of an alcohol-impregnated sponge...
OBJECTIVE
To evaluate the clinical outcomes of patients who underwent corneal surgery with debridement of epithelium by localised application of an alcohol-impregnated sponge instead of the usual alcohol reservoir method.
DESIGN
This study retrospectively included 52 eyes of 27 patients who underwent LASEK (laser-assisted subepithelial keratectomy) and CXL (cross-linking) surgery after application of this alcohol-assisted debridement method between January 2019 and April 2019.
PARTICIPANTS
Twenty-four patients who underwent LASEK and three patients who underwent CXL surgery were included in this study, which comprised a total of 52 eye operations.
METHODS
Epithelial debridement was performed after placing a 20% ethanol-impregnated sponge on the cornea for 20 seconds.
RESULTS
The mean pachymetry value was 509.40 ± 30.37 µm, the mean preoperative spherical equivalent was - 2.14 ± 1.02 dioptres, and the highest myopia and astigmatism values were - 4.25 dioptres and - 2.75 dioptres, respectively. It was seen that the corneal epithelium was completely and easily debrided in a size identical to that of the applied sponge.
CONCLUSIONS
Complete debridement of the corneal epithelium can be performed quickly, safely, and easily with this specially prepared sponge.
Topics: Cornea; Debridement; Epithelium, Corneal; Humans; Keratectomy, Subepithelial, Laser-Assisted; Lasers, Excimer; Photorefractive Keratectomy; Refraction, Ocular; Retrospective Studies; Visual Acuity
PubMed: 33733442
DOI: 10.1055/a-1327-3156 -
Annals of Medicine Dec 2023Infections are rare and poorly studied complications of unicompartmental knee arthroplasty (UKA) surgery. They are significantly less common compared to infections after...
BACKGROUND
Infections are rare and poorly studied complications of unicompartmental knee arthroplasty (UKA) surgery. They are significantly less common compared to infections after total knee arthroplasties (TKAs). Optimal management of periprosthetic joint infections (PJIs) after a UKA is not clearly defined in the literature. This article presents the results of the largest multicentre clinical study of UKA PJIs treated with Debridement, Antibiotics and Implant Retention (DAIR).
MATERIALS AND METHODS
In this retrospective case series, patients presenting between January 2016 and December 2019 with early UKA infection were identified at three specialist centres using the Musculoskeletal Infection Society (MSIS) criteria. All patients underwent a standardized treatment protocol consisting of the DAIR procedure and antibiotic therapy comprising two weeks of intravenous (IV) antibiotics followed by six weeks of oral therapy. The main outcome measure was overall survivorship free from reoperation for infection.
RESULTS
A total of 3225 UKAs (2793 (86.2%) medial and 432 (13.8%) lateral UKAs) were performed between January 2016 and December 2019. Nineteen patients had early infections necessitating DAIR. The mean follow-up period was 32.5 months. DAIR showed an overall survivorship free from septic reoperation of 84.2%, with overall survivorship free from all-cause reoperation of 78.95%.The most common bacteria were Coagulase-negative , and Group B . Three patients required a second DAIR procedure but remained free from re-infection at follow-up obviating the need for more demanding, staged revision surgery.
CONCLUSIONS
In infected UKAs, the DAIR procedure produces a high rate of success, with a high survivorship of the implant.Key messagesDebridement, Antibiotics and Implant Retention (DAIR) is a successful and minimally invasive surgical option for the management of periprosthetic joint infections (PJIs) after UKA.The surface area available for bacteria to colonise is much smaller in UKAs compared to total knee arthroplasties (TKAs), and this may account for the higher success rates of the DAIR procedure in infected UKAs versus infected TKAs.A second DAIR procedure can be considered in the management of the early recurrence of PJIs with a well-fixed UKA.
Topics: Humans; Arthroplasty, Replacement, Knee; Retrospective Studies; Debridement; Anti-Bacterial Agents; Treatment Outcome; Prosthesis-Related Infections; Arthritis, Infectious
PubMed: 37074322
DOI: 10.1080/07853890.2023.2179105 -
Plastic and Reconstructive Surgery Jan 2021The use of negative-pressure wound therapy (NPWT) has become an established therapy for wound management. There have been many advancements in the technology of NPWT... (Review)
Review
The use of negative-pressure wound therapy (NPWT) has become an established therapy for wound management. There have been many advancements in the technology of NPWT including NPWT with instillation and dwell (NPWTi-d). NPWTi-d promotes wound healing by wound cleansing, irrigation, and nonexcisional debridement. NPWTi-d has been shown in comparative clinical studies to decrease the time to definitive wound healing and length of hospitalization. NPWTi-d-using a reticulated open-cell foam dressing with "through" holes (ROCF-CC)-has been postulated to facilitate solubilization, detachment, and elimination of infectious materials, such as slough and thick exudate, before or after operative debridement, and in cases where surgical debridement is not an option. The authors provide an overview on the use of NPWTi-d by reviewing the components of the system, proposed mechanism of action, clinical outcomes, and current consensus guidelines for its utilization.
Topics: Anti-Infective Agents, Local; Bandages; Consensus; Debridement; Humans; Instillation, Drug; Negative-Pressure Wound Therapy; Practice Guidelines as Topic; Therapeutic Irrigation; Wound Healing; Wound Infection; Wounds and Injuries
PubMed: 33347059
DOI: 10.1097/PRS.0000000000007607 -
The British Journal of Surgery Mar 2022Tangential excision of burned tissue followed by skin grafting is the cornerstone of burn surgery. Hydrosurgery has become popular for tangential excision, with the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Tangential excision of burned tissue followed by skin grafting is the cornerstone of burn surgery. Hydrosurgery has become popular for tangential excision, with the hypothesis that enhanced preservation of vital dermal tissue reduces scarring. The aim of this trial was to compare scar quality after hydrosurgical versus conventional debridement before split-skin grafting.
METHODS
A double-blind randomized within-patient multicentre controlled trial was conducted in patients with burns that required split-skin grafting. One wound area was randomized to hydrosurgical debridement and the other to Weck knife debridement. The primary outcome was scar quality at 12 months, assessed with the observer part of the Patient and Observer Scar Assessment Scale (POSAS). Secondary outcomes included complications, scar quality, colour, pliability, and histological dermal preservation.
RESULTS
Some 137 patients were randomized. At 12 months, scars of the hydrosurgical debrided wounds had a lower POSAS observer total item score (mean 2.42 (95 per cent c.i. 2.26 to 2.59) versus 2.54 (95 per cent c.i. 2.36 to 2.72; P = 0.023)) and overall opinion score (mean 3.08 (95 per cent c.i. 2.88 to 3.28) versus 3.30 (95 per cent c.i. 3.09-3.51); P = 0.006). Patient-reported scar quality and pliability measurements were significantly better for the hydrosurgically debrided wounds. Complication rates did not differ between both treatments. Histologically, significantly more dermis was preserved with hydrosurgery (P < 0.001).
CONCLUSION
One year after surgery scar quality and pliability was better for hydrosurgically debrided burns, probably owing to enhanced histological preservation of dermis.
REGISTRATION NUMBER
Trial NL6085 (NTR6232 (http://www.trialregister.nl)).
Topics: Burns; Cicatrix; Debridement; Humans; Skin; Skin Transplantation
PubMed: 35237788
DOI: 10.1093/bjs/znab470 -
Journal of Medicine and Life Aug 2023Inflammation and hypertrophy of the ankle joint's synovial lining can occur due to various causes. Chronic pain and degenerative changes may be due to synovitis causing...
Inflammation and hypertrophy of the ankle joint's synovial lining can occur due to various causes. Chronic pain and degenerative changes may be due to synovitis causing clinical manifestations through traction on the joint capsule. The failure of conservative treatment for at least six months indicates arthroscopic debridement, which can provide significant pain relief without the morbidity of extensive surgical exposures. This study was therefore conducted to establish the functional results of arthroscopic debridement of the ankle joint in synovitis. Fifteen patients with chronic ankle pain who had not responded to conservative treatment for approximately six months were included in the study. Arthroscopic debridement was performed using a shaver blade, followed by a postoperative ankle physiotherapy regimen. Patients were assessed preoperatively and postoperatively using the AOFAS, FADI, and VAS scores, with a mean follow-up period of 26 months. There was a significant improvement in the final clinical outcomes of the patients. The post-operative VAS score improved to 2.20±0.56 (2-4) (p-value=0.001), the AOFAS score was 86±8.25 (65-98) (p-value-0.001), and the FADI Score was 86.93±7.35(70-96) (p-value=0.001). Thirteen patients (86.67%) achieved outstanding or good results, while two had fair results, according to Meislin's criterion. One patient reported a superficial wound infection, which subsided with antibiotic therapy. The study findings indicate that arthroscopic ankle debridement is an efficient method to treat persistent ankle discomfort induced by synovitis, and it has a low postsurgical complications rate, quicker recovery, and less joint stiffness.
Topics: Humans; Ankle; Ankle Joint; Debridement; Synovitis; Pain; Retrospective Studies; Treatment Outcome
PubMed: 38024814
DOI: 10.25122/jml-2023-0117