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Surgical Technology International May 2020The surgical surgical debridement of wounds has evolved over the past 250 years. At that time, the amputation of extremities was recognized as a life-saving procedure to...
The surgical surgical debridement of wounds has evolved over the past 250 years. At that time, the amputation of extremities was recognized as a life-saving procedure to treat major wounds suffered in combat. This continued until after World War I. As the survival of patients with diabetes and other chronic conditions improved, and as advanced therapies were developed to meet the needs of an increasing number of patients with chronic wounds, debridement became a focal point of surgical wound care. It is now well-established that debridement enhances wound-healing and improves the efficacy of advanced therapies and surgical closure. Up until the last two decades, sharp excision with "cold steel" was the only option for debridement. In the early 2000's, a high-power waterjet was introduced, and provided a more precise debridement of wound surfaces. As our understanding of biofilms increased, so came the realization that biofilms are stratified within the wound, with anaerobic species preferentially developing deeper within the wound. The latest surgical instrument for wound debridement, the direct contact low frequency ultrasound device (DCLFU), has recently been introduced. A vacuum sheath was added to the active tip to contain spray dispersion. The device is capable of removing all of the wound tissue including biofilm down to a healthy base. This allows for optimal preparation of the wound prior to deployment of an advanced therapy, graft, or flap. This instrumentation is designed specifically for use in the operating room. However, the manufacturer has recently introduced a less powerful, but still effective, version for use in the outpatient clinic. These advances in surgical debridement technology have paved the way for more effective subsequent interventions for treating chronic wounds.
Topics: Amputation, Surgical; Biofilms; Debridement; Diabetes Mellitus; Humans; Wound Healing
PubMed: 32250443
DOI: No ID Found -
Methods in Molecular Biology (Clifton,... 2021A murine model of corneal epithelial wounding can be performed using simple injury and imaging methods. Here, we describe the creation of a central corneal epithelial...
A murine model of corneal epithelial wounding can be performed using simple injury and imaging methods. Here, we describe the creation of a central corneal epithelial defect using mechanical debridement under ophthalmic microscopic visualization. Subsequent monitoring with vital dye application and slit-lamp bio microscopy (slit-lamp) is described in detail.
Topics: Animals; Corneal Injuries; Debridement; Disease Models, Animal; Epithelium, Corneal; Mice; Mice, Inbred C57BL; Ophthalmologic Surgical Procedures; Wound Healing
PubMed: 32808269
DOI: 10.1007/978-1-0716-0845-6_17 -
International Wound Journal Dec 2023In 2012 the European Medicines Agency approved a pineapple stem-derived Bromelain-based debridement concentrate of proteolytic enzymes (NexoBrid®, MediWound Ltd, Yavne,...
In 2012 the European Medicines Agency approved a pineapple stem-derived Bromelain-based debridement concentrate of proteolytic enzymes (NexoBrid®, MediWound Ltd, Yavne, Israel) for adult deep burns. Over 10 000 patients have been successfully treated with NexoBrid® globally, including in the US. The aim of our study is to perform a systematic review of the current literature on Nexobrid® outcomes. We conducted a literature search in PubMed, Google Scholar, Embase, and other search engines (2013-2023). The online screening process was performed by two independent reviewers with the Covidence tool. The protocol was reported using the Preferred Reporting Items for Systematic Review and Meta-Analyses, and it was registered at the International Prospective Register of Systematic Reviews of the National Institute for Health Research. We identified 103 relevant studies of which 34 were found eligible. The included studies report the positive effects of Nexobrid® on burn debridement, functional and cosmetic outcomes, scarring, and quality of life. Also, they validate the high patient satisfaction thanks to enhanced protocols of analgosedation and/or locoregional anaesthesia during Bromelain-based debridement. Two studies investigate potential risks (coagulopathy, burn wound infection) which concluded there is no strong evidence of these adverse events. NexoBrid® is a safe, selective, non-surgical eschar removal treatment modality. The benefits of Bromelain-based debridement are faster debridement and healing times, reduced operations, length of stay, cases of sepsis, blood transfusions, and prevention of compartment syndrome. Existing evidence suggests that the indications and the role of Bromelain-based debridement are expanding to cover "off-label" cases with significant benefits to the global healthcare economy.
Topics: Adult; Humans; Bromelains; Burns; Debridement; Patient Safety; Quality of Life; Systematic Reviews as Topic
PubMed: 37455553
DOI: 10.1111/iwj.14308 -
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 -
Journal of Wound Care Sep 2019
Topics: Bandages; Carboxymethylcellulose Sodium; Debridement; Wound Healing
PubMed: 31536458
DOI: 10.12968/jowc.2019.28.Sup9a.S3 -
Hand Clinics Aug 2020Necrotizing soft tissue infections of the upper extremity have varying microbiologies and etiologies. Risk factors for development include diabetes mellitus, intravenous... (Review)
Review
Necrotizing soft tissue infections of the upper extremity have varying microbiologies and etiologies. Risk factors for development include diabetes mellitus, intravenous drug use, peripheral arterial disease, smoking, alcohol abuse, and immunocompromised state. Although clinical examination is the mainstay of diagnosis, laboratory tests and imaging can aid in diagnosis. Surgical débridements usually are needed for treatment, with resultant defects that often require reconstruction. Rates of amputation are reported as 22% to 37.5% and mortality from necrotizing soft tissue infections of the upper extremity from 22% to 34%. Prompt surgical and antimicrobial treatment is necessary to decrease risk of loss of limb or life.
Topics: Amputation, Surgical; Anti-Bacterial Agents; Debridement; Fasciotomy; Humans; Medical History Taking; Necrosis; Physical Examination; Soft Tissue Infections; Surgical Flaps; Upper Extremity
PubMed: 32586460
DOI: 10.1016/j.hcl.2020.03.007 -
Clinical Rheumatology Mar 2020Optimal wound care is an essential component in the management of systemic sclerosis (SSc) digital ulcers (DUs). DU debridement has been suggested to reduce...
Optimal wound care is an essential component in the management of systemic sclerosis (SSc) digital ulcers (DUs). DU debridement has been suggested to reduce ulcer-related pain and improve tissue healing. However, only a minority of rheumatologists perform DU debridement, and there is no standard of care/protocol. Our objectives were to (i) evaluate the current evidence for the use of debridement in DU management and (ii) assess whether there are any specific protocols. A systematic literature review was performed searching the PubMed database (between 01/01/1950-01/03/2019) in accordance with PRISMA guidelines. Two independent reviewers screened and extracted the abstracts/full manuscripts. Articles in English, which focussed on SSc-DU debridement/curettage, were included. Exclusion criteria included studies of juvenile/paediatric patients and basic/non-clinical research. Our search identified 1497 studies of which 4 studies were included in our final analysis. Three studies used scalpel debridement, and one study used this in combination with autolytic debridement. No studies specifically reported the effect on DU healing from debridement. Autolytic debridement with hyaluronate-based products was associated with significant ulcer pain and inflammation. Local anaesthetic significantly reduces pain both during and after debridement. Combined local and oral analgesia is often required for more severe or infected DUs. DU (scalpel and autolytic) debridement is being used by some clinicians in rheumatology; however, there are no standardised protocols. To improve wound care for SSc-DUs, future research should focus on developing a standardised protocol for SSc-DU debridement, with a view to facilitate randomised controlled trials to demonstrate safety and treatment efficacy.Key Points• Optimal wound care is an essential component in the management of systemic sclerosis-digital ulcers.• 'Sharp' debridement uses a scalpel, whereas 'autolytic' debridement uses dressings to optimize endogenous tissue lysis.• There is significant variation in the use of digital ulcer debridement in systemic sclerosis.• A standardized protocol and randomized controlled trials are needed to demonstrate debridement the safety and efficacy of digital ulcer debridement in systemic sclerosis.
Topics: Anesthetics, Local; Debridement; Fingers; Humans; Pain; Pain Management; Scleroderma, Systemic; Skin Ulcer; Wound Healing
PubMed: 31955323
DOI: 10.1007/s10067-019-04924-4 -
BMJ Case Reports Sep 2023A rubber band worn around a limb in an infant has the potential to cut through the tissues. The cutting potential of a rubber band is proportional to the strain within...
A rubber band worn around a limb in an infant has the potential to cut through the tissues. The cutting potential of a rubber band is proportional to the strain within the band. A circumferential scar over the wrist with multiple discharging sinuses is the usual presentation. Such presentations should raise the suspicion of 'the rubber band syndrome'. A forgotten band migrates through the tissues and the skin epithelialises over it. As a result, continuity and function in the limb may be maintained, leading to misdiagnosis and wrong treatment. A high level of suspicion and treatment in the form of surgical removal and adequate debridement at first followed by formal reconstruction of deficits secondarily are required in the management of such patients.
Topics: Humans; Infant; Wrist; Male; Ligation; Foreign Bodies; Debridement; Wrist Injuries
PubMed: 37751978
DOI: 10.1136/bcr-2023-255583 -
Journal of Neurosurgical Sciences Jun 2022Primary spondylodiscitis is a medically challenging disease that can lead to recurrent back pain, progressive kyphotic deformity, and neurologic deficits. The incidence...
There is no difference in perioperative results between posterior instrumentation with and without interbody cage and debridement in primary spondylodiscitis in adults: a multicenter surveillance study from the German Spine Registry (DWG Register).
BACKGROUND
Primary spondylodiscitis is a medically challenging disease that can lead to recurrent back pain, progressive kyphotic deformity, and neurologic deficits. The incidence rate of primary non-tuberculosis spondylodiscitis has been estimated from 2.2 to 2.4 cases per 100,000 person-years, and it has been reported to be increasing because of the aging population. The objectives were to determine the safety and efficacy of posterior instrumentation (PI) with and without interbody cage, bony attachment and debridement in the treatment of primary spondylodiscitis by comparing perioperative data, functional outcomes, and overall infection-free survival.
METHODS
Analysis of data from the DWG Registry on patients who have undergone posterior instrumentation with and without interbody cage, bony attachment and debridement in primary spondylodiscitis from the thoracolumbar junction to S1 (Th10-S1) at 10 institutions from January 2012 to December 2016.
RESULTS
In total, 420 posterior instrumentations with and without interbody cage, bony attachment and debridement in primary spondylodiscitis in the thoracolumbar junction to S1 were identified in the registry; N.=138 were exclusively percutaneous posterior instrumented (PPI), while N.=102 underwent open posterior instrumentation (OPI) without interbody cage, bony attachment and debridement and N.=180 OPI with interbody cage, bony attachment and debridement. Clinical evaluation after surgery did not show a significant difference between groups including improvement of the mobilization and infection-free survival. However, with PPI the duration of operation and blood loss was significantly less than OPI with and without interbody cage, bony attachment and debridement.
CONCLUSIONS
The results suggest interbody cage, bony attachment and debridement as not indispensable for treatment in primary spondylodiscitis. Therefore, we encourage the use of posterior stabilization alone in the treatment of spondylodiscitis as less invasive procedure reducing costs in instrumentation.
Topics: Adult; Aged; Debridement; Discitis; Humans; Lumbar Vertebrae; Registries; Retrospective Studies; Spinal Fusion; Treatment Outcome
PubMed: 32909418
DOI: 10.23736/S0390-5616.19.04869-0 -
The Journal of the American Academy of... Dec 2022In the treatment of native knee bacterial septic arthritis, the optimal irrigation and débridement modality-arthroscopic versus open-is a matter of controversy. We aim...
BACKGROUND
In the treatment of native knee bacterial septic arthritis, the optimal irrigation and débridement modality-arthroscopic versus open-is a matter of controversy. We aim to compare revision-free survival, complications, and resource utilization between these approaches.
METHODS
The National Readmission Database was queried from 2016 to 2019 to identify patients using International Classification of Diseases, 10th revision, diagnostic and procedure codes. Days to revision irrigation and débridement (I&D), if any, were calculated for patients during index admission or subsequent readmissions. Multivariate regression was used for healthcare utilization analysis. Survival analysis was done using Kaplan-Meier analysis and Cox proportional hazard regression.
RESULTS
A total of 14,365 patients with native knee septic arthritis undergoing I&D were identified, 8,063 arthroscopic (56.1%) and 6,302 open (43.9%). The mean follow-up was 148 days (interquartile range 53 to 259). A total of 2,156 patients (15.0%) underwent revision I&D. On multivariate analysis, arthroscopic I&D was associated with a reduction in hospital costs of $5,674 and length of stay of 1.46 days (P < 0.001 for both). Arthroscopic I&D was associated with lower overall complications (odds ratio [OR] 0.63, P < 0.001), need for blood transfusion (OR 0.58, P < 0.001), and wound complications (OR 0.32, P < 0.001). Revision-free survival after index I&D was 95.3% at 3 days, 91.0% at 10 days, 88.3% at 30 days, 86.0% at 90 days, and 84.5% at 180 days. No statistically significant difference was observed between surgical approaches on Cox modeling.
DISCUSSION
Risk of revision I&D did not differ between arthroscopic and open I&D; however, arthroscopy was associated with decreased costs, length of stay, and complications. Additional study is necessary to confirm these findings and characterize which patients require an open I&D.
LEVEL OF EVIDENCE
III.
Topics: Humans; Debridement; Length of Stay; Therapeutic Irrigation; Retrospective Studies; Arthritis, Infectious
PubMed: 36400061
DOI: 10.5435/JAAOS-D-22-00315