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Advances in Skin & Wound Care Apr 2021
Topics: Debridement; Education, Continuing; Humans; Wound Healing; Wounds and Injuries
PubMed: 33739954
DOI: 10.1097/01.ASW.0000735256.97359.dd -
Frontiers in Public Health 2023The choice of the debridement method is very important for the healing of diabetic foot ulcers (DFUs), but the relative effectiveness of different debridement methods in... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The choice of the debridement method is very important for the healing of diabetic foot ulcers (DFUs), but the relative effectiveness of different debridement methods in the healing of DFUs remains unclear. This study conducted a network meta-analysis of the relative healing effectiveness of different debridement methods in patients with DFUs.
METHODS
We performed a literature search in PubMed, Embase, and Cochrane Library from database inception up to 30 June 2023 for screening randomized controlled trials on the healing effectiveness of debridement in DFUs. Outcome measures included ulcer healing rate and ulcer area reduction rate. The Cochrane Risk Bias Tool, version 2.0, was used to assess the risk of bias in the included trials. R software was used for performing statistical analysis and GraphPad Prism was used for image plotting.
RESULTS
A total of 19 randomized controlled trials were included, and 900 patients with DFUs were assessed in this analysis. The proteolytic fraction from the latex of (P1G10) in enzymatic debridement showed the best ulcer healing rate (SURCA = 0.919) when compared with the standard of care (SOC) group, with a mean difference (MD) and 95% confidence interval (CI) of 1.40 (0.57, 2.36). Kiwifruit extract demonstrated the best effect on the ulcer area reduction rate (SURCA = 0.931), when compared with that in the SOC group, with an MD and 95% CI of 0.47 (0.27, 0.66).
CONCLUSION
Enzymatic debridement was superior to other debridement methods in terms of ulcer healing rate and ulcer area reduction rate in patients with DFUs. However, as the quality of the included trials is low, enzymatic debridement can be used as a candidate debridement method in addition to sharp-based debridement in clinical practice.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023441715.
Topics: Humans; Diabetic Foot; Debridement; Network Meta-Analysis; Randomized Controlled Trials as Topic; Wound Healing; Diabetes Mellitus
PubMed: 38146472
DOI: 10.3389/fpubh.2023.1271706 -
Journal of Wound Care Nov 2022Maggot debridement therapy (MDT) is an emerging procedure involving the application of sterile maggots of the Dipteran species (commonly ) to effect debridement,...
OBJECTIVE
Maggot debridement therapy (MDT) is an emerging procedure involving the application of sterile maggots of the Dipteran species (commonly ) to effect debridement, disinfection and promote healing in wounds not responding to antimicrobial therapy. Data on MDT in sub-Saharan Africa (including Nigeria) are scarce. This study aimed to use medicinal grade maggots as a complementary method to debride hard-to-heal necrotic ulcers and thereby promote wound healing.
METHOD
In this descriptive study, we reported on the first group of patients who had MDT at Aminu Kano Teaching Hospital (AKTH), a tertiary hospital in northern Nigeria. The first instar larvae of were applied using the confinement (free-range) maggot therapy dressing method under aseptic conditions.
RESULTS
Diabetic foot ulcer (DFU) grade III-IV constituted more than half of the wounds (53.3%), followed by necrotising fasciitis (30%), and post-traumatic wound infection (10%). Others (6.7%, included pyomyositis, surgical site infection and post traumatic wound infection). The median surface area of the wounds was 56cm. Of the 30 patients, half (50%) had two MDT cycles with a median time of four days. Of the wounds, 22 (73%) were completely debrided using maggots alone while eight (27%) achieved complete debridement together with surgical debridement. Wound culture pre-MDT yielded bacterial growth for all the patients and was the predominant isolate in 17 wounds (56.7%) while and were predominant in five wounds (16.7%) each. Only four (13.3%) wound cultures yielded bacterial growth after MDT, all .
CONCLUSION
A good prognosis was achieved post-MDT for various wounds. MDT effectively debrides and significantly disinfects wounds involving different anatomical sites, thus enhancing wound healing and recovery. MDT is recommended in such wounds.
Topics: Animals; Humans; Debridement; Nigeria; Diabetic Foot; Diptera; Larva; Wound Infection; Staphylococcal Infections
PubMed: 36367805
DOI: 10.12968/jowc.2022.31.11.996 -
Journal of Burn Care & Research :... Sep 2020The use of intermediate skin substitutes between debridement and final autografting is routine for many practitioners. Materials such as xenografts and allografts have...
The use of intermediate skin substitutes between debridement and final autografting is routine for many practitioners. Materials such as xenografts and allografts have been promoted to help with wound coverage before autografting. However, there is limited data for their use in relatively small burn wounds (<10% TBSA). In this study, we analyzed the outcomes of 100 consecutive patients who underwent autografting for burns <10% TBSA at our American Burn Association-verified burn unit in the absence of intermediate skin substitute use. We retrospectively analyzed 100 patients who underwent split thickness skin graft autografting for burns <10% TBSA between November 2017 and June 2019. No patients were treated with intermediate skin substitutes. Analysis included basic demographics, comorbidities, TBSA burned, mechanism of burn, time to grafting, if grafting was performed in a single procedure or staged, graft loss (>50% graft failure), and time to complete healing (no further wound care required). Twelve patients (12%) had unpredictable graft beds, and their procedure was staged. These patients underwent surgical debridement and were dressed in antimicrobial dressing for an average of 5 days before autografting. No patients had intermediate skin substitutes between procedures. Eighty-eight patients (88%) were debrided and grafted in a single stage. In the staged group, there was a 0% rate of graft failure compared with 9.1% rate of graft failure in the primarily grafted group (P = .004). There was a similar length of stay and time to complete healing in the staged group and primarily grafted group (P = .496 and P = .571). There was a significantly shorter time from injury to first procedure between the staged group and the primarily grafted group (8.7 days and 13.5 days, P = .014). In the eight instances of graft failure, infection or inadequate debridement was the cause. Seven of these eight cases required further surgical intervention. Intermediate skin substitutes are an unnecessary step in grafting small burns. These add only complexity and cost to patient care. Many patients can be debrided and grafted in a single stage. Debridement alone with delayed grafting is a highly effective surgical method when the wound bed is not suitable for immediate grafting. The use of intermediate skin substitutes in small burns requires further investigation as this study finds low benefit for this product.
Topics: Adult; Burns; Debridement; Female; Humans; Male; Middle Aged; Retrospective Studies; Skin Transplantation; Skin, Artificial; Treatment Outcome; Wound Healing
PubMed: 32485731
DOI: 10.1093/jbcr/iraa077 -
The International Journal of Lower... Dec 2020Chronic wounds cause considerable morbidity and utilize significant health care resources. In addition to addressing wound etiology and treating infection, regular... (Review)
Review
Chronic wounds cause considerable morbidity and utilize significant health care resources. In addition to addressing wound etiology and treating infection, regular debridement is a key component of wound care with a proven ability to accelerate healing. In this regard, a significant innovation in wound care has been the development of ultrasound debridement technology. The purpose of this review is to evaluate the current evidence behind the technology with an emphasis on noncontact low-frequency (NCLF) ultrasound. A number of studies, especially those evaluating NCLF technology, have demonstrated the potential of ultrasound debridement to effectively remove devitalized tissue, control bioburden, alleviate pain, and expedite healing. However, most of the studies are underpowered, involve heterogeneous ulcer types, and demonstrate significant methodological limitations making comparison between studies difficult; there is a paucity of data on cost-effectiveness. Future clinical trials on ultrasound debridement technology must address the design issues prevalent in current studies, and report on clinically relevant endpoints before adoption into best-practice algorithms can be recommended.
Topics: Chronic Disease; Debridement; Humans; Leg Ulcer; Surgery, Computer-Assisted; Ultrasonography
PubMed: 32787600
DOI: 10.1177/1534734620946660 -
Journal of Wound Care Sep 2019Best practice in wound bed preparation and biofilm-based wound management includes debridement to create a clean wound bed and to assist in minimising the redevelopment...
OBJECTIVE
Best practice in wound bed preparation and biofilm-based wound management includes debridement to create a clean wound bed and to assist in minimising the redevelopment of biofilm. Biofilm that is not removed inhibits healing and redevelops if not prevented from doing so with topical antimicrobial agents. Monofilament fibre debriding technology (MFDT) is used for effective and rapid mechanical debridement of loose material, slough and biofilm. The objective of this evaluation was to determine the clinical effect and consequential levels of health professional and patient satisfaction with the results of a biofilm pathway that included MFDT to achieve debridement.
METHODS
This non-comparative, open label evaluation was conducted in static and non-static wounds that required debridement. MFDT was used to debride in a two-week evaluation of a biofilm pathway. Wounds were debrided three times in week one and twice in week two. Each debridement was followed by treatment with an antimicrobial dressing. Other care included secondary dressings and compression delivered according to local practice, guidelines and formularies. After the clinical evaluation, health professionals were invited to complete an online survey of the clinical outcomes and their satisfaction with the biofilm pathway.
RESULTS
There were 706 health professionals who provided answers to the survey questions. Wound types evaluated were leg ulcers (67.4%), pressure ulcers (10%), dehisced surgical wounds (1.7%), diabetic foot ulcers (7.4%) and other wounds (13.4%). Of the wounds, 9% were reported as non-static despite the eligibility criteria. Not all wounds followed the pathway. The most frequently-used antimicrobial was silver. Non-antimicrobial products used included all-in-one dressings, other secondary dressings and compression. There was a change in 77% of wounds overall after two weeks. Change was reported almost equally for both static and non-static wounds. Health professionals who did or did not follow the pathway were 'completely satisfied' or 'satisfied' with the overall clinical outcome 96% and 95%, respectively. Of the patients, 77% were 'completely satisfied' or 'satisfied' with healing after following the pathway, as reported by the treating health professional.
CONCLUSION
The biofilm pathway that includes MFDT appears effective. Wounds managed on the pathway were debrided effectively and healing progressed to the satisfaction of both health professionals and patients.
Topics: Anti-Infective Agents; Biofilms; Clinical Competence; Debridement; Disease Management; Health Personnel; Humans; Patient Satisfaction; Wound Infection
PubMed: 31513491
DOI: 10.12968/jowc.2019.28.9.608 -
Journal of Wound Care Sep 2021Maggot debridement therapy (MDT), or the use of maggots in dead tissue removal, has been shown to be beneficial in wound healing. Yet MDT in the US is often only used...
BACKGROUND
Maggot debridement therapy (MDT), or the use of maggots in dead tissue removal, has been shown to be beneficial in wound healing. Yet MDT in the US is often only used once conventional debridement methods have failed.
METHOD
In this study, nine health professionals, experienced in MDT, were interviewed in order to identify and analyse the perceived societal barriers to MDT acceptance and usage in the US.
RESULTS
Through qualitative analysis, using the grounded theory framework, this study found that among those interviewed, insurance reimbursement restrictions and stigmatisation of medicinal maggots were the factors driving resistance to MDT use.
CONCLUSION
Specifically, the 'yuck' factor and the perception of MDT as an 'ancient' modality contributed towards MDT stigma; in addition, lack of outpatient insurance coverage deterred MDT use. These findings provide useful information regarding the perceptual and systemic barriers that prevent greater acceptance of MDT. Ultimately, these barriers must be understood if we are to facilitate MDT implementation and improve MDT usage in the future.
Topics: Animals; Debridement; Dermatologic Surgical Procedures; Humans; Larva; Perception; Wound Healing
PubMed: 34570633
DOI: 10.12968/jowc.2021.30.Sup9a.VII -
Orthopaedics & Traumatology, Surgery &... Dec 2019Elbow osteoarthritis chiefly affects heavy manual labourers and athletes and may be primary or post-traumatic. Arthroscopic debridement for primary elbow osteoarthritis...
Elbow osteoarthritis chiefly affects heavy manual labourers and athletes and may be primary or post-traumatic. Arthroscopic debridement for primary elbow osteoarthritis reliably produces pain relief, motion range gains, and good functional outcomes. Total elbow arthroplasty, in contrast, is considered a salvage option in this patient population, as activities must be restricted to protect the implant. Here, we describe the operative technique used for arthroscopic elbow release in 87 patients with symptomatic elbow osteoarthritis included prospectively at 6 centres in a study that was conducted for a French Arthroscopy Society symposium and whose findings are reported elsewhere. The technique involves exploration of the anterior and posterior compartments with resection of motion-limiting osteophytes; clearing of the fossae; foreign body extraction; and treatment of the posterior and anterior capsule and of the lateral inclines. The indications of ulnar nerve release, radial head excision, release of the posterior band of the medial collateral ligament (MCL), and/or fenestration as described by Outerbridge-Kashiwagi are discussed. After 6 months, 93.5% of patients were satisfied with the procedure. No serious neurological complications were recorded. Wound healing was impaired in 4 patients, of whom 3 responded to local care; the remaining patient required open debridement for surgical-site infection. Complex regional pain syndrome developed in 3 patients. Ulnar nerve transposition was required secondarily in 1 patient and another patient had persistent dysesthesia after ulnar nerve release. This minimally invasive technique provides good short-term outcomes in primary elbow osteoarthritis and is associated with a low complication rate.
Topics: Adolescent; Adult; Aged; Arthroscopy; Complex Regional Pain Syndromes; Debridement; Elbow Joint; Humans; Joint Loose Bodies; Middle Aged; Osteoarthritis; Osteophyte; Patient Satisfaction; Radius; Range of Motion, Articular; Surgical Wound Infection; Ulnar Nerve; Wound Healing; Young Adult
PubMed: 31558411
DOI: 10.1016/j.otsr.2019.09.003 -
The American Journal of Sports Medicine Mar 2022Short- and midterm follow-up studies suggest that arthroscopic labral refixation/preservation leads to superior outcomes compared with labral excision/debridement.
BACKGROUND
Short- and midterm follow-up studies suggest that arthroscopic labral refixation/preservation leads to superior outcomes compared with labral excision/debridement.
PURPOSE
To update the previous early (16 months) and midterm (mean, 42 months) follow-up of this cohort, which reported better patient-reported outcome measures and lower failure rates in the repair/refixation group.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
The authors identified patients who underwent labral debridement/focal labral excision during a period before the development of labral repair techniques. A consecutive group of patients within the labral debridement group thought to be repairable with the authors' current arthroscopic techniques were compared with a group of consecutive patients who underwent labral repair/refixation. In 46 hips, the labrum was focally excised/debrided consistent with pincer- or combined pincer- and cam-type impingement; in 54 hips, the labrum was repaired/refixed. Subjective outcomes were measured with the modified Harris Hip Score (mHHS), 12-Item Short Form Health Survey (SF-12), and visual analog scale (VAS) for pain preoperatively and postoperatively.
RESULTS
The mean age was 34.0 years in the debridement group and 28.3 years in the repair/refixation group, with a mean follow-up of 7.3 years (range, 2-13.6 years). At the mean follow-up of 7.3 years, subjective outcomes were significantly improved ( < .01) for both groups compared with preoperative scores. The mHHS ( = .008), SF-12 score ( = .012), and VAS pain score ( = .002) were all significantly better for the repair/refixation group compared with the debridement group. Although most recent outcomes for both groups fell slightly at the mean follow-up of 7.3 years in comparison with the 16-month and 3.5-year follow-ups, these differences were not significant. However, the failure rate in the debridement group did get significantly worse ( = .014). Good to excellent results were 47.7% in the debridement group and 86.3% in the refixation group ( < .001), and failure rates were 30.4% (debridement) and 13% (refixation) ( = .033). There were 4 revisions in the debridement group and 3 revisions in the refixation group.
CONCLUSION
Longer term, >7-year follow-up comparing focal labral excision/debridement with repair/refixation revealed better patient-reported outcomes and lower failure rates in the labral repair/refixation cohort. Additionally, despite an absolute decrease in patient-related outcome scoring and number of good/excellent results in both groups compared with the 3.5-year report, there was a significantly greater increase in failure rates over time for the excision/debridement group with better maintenance of good to excellent results in the repair/refixation group.
Topics: Adult; Arthroscopy; Cohort Studies; Debridement; Femoracetabular Impingement; Follow-Up Studies; Hip Joint; Humans; Retrospective Studies; Treatment Outcome
PubMed: 35099305
DOI: 10.1177/03635465211067818 -
Veterinary Ophthalmology Nov 2020To evaluate the clinical course and outcome of canine SCCEDs treated with a combination of cotton-tip debridement (CTD), scalpel blade debridement (SBD), and superficial...
Cotton-tip debridement, scalpel blade debridement, and superficial grid keratotomy for treatment of spontaneous chronic corneal epithelial defects (SCCED): A retrospective evaluation of 308 cases.
PURPOSE
To evaluate the clinical course and outcome of canine SCCEDs treated with a combination of cotton-tip debridement (CTD), scalpel blade debridement (SBD), and superficial grid keratotomy (SGK).
METHODS
Medical records of dogs diagnosed with SCCED and treated by the same diplomate (FJO) from 2011 to 2019 were reviewed. Age, breed, sex, affected eye, time of onset before treatment, previous procedures performed, time to healing, need for a second treatment, and complications were reported.
RESULTS
A total of 308 eyes (291 dogs) met the inclusion criteria and were included in the study. All dogs received the same treatment (CTD + SBD + SGK) and the same topical medication (tobramycin 0.3% solution and sodium chloride 5% ointment). All eyes healed. Mean age at presentation was 9 years and 6 months (114.4 ± SD 28.0 months), and Boxer was the most common breed (93/308; 30.2%). Mean corneal healing time was 11.5 days (±SD 6.6). Complications occurred in 15/308 (4.9%) eyes. The three main complications observed were infected epithelial ulcer, infected stromal ulcer, and melting corneal ulcer, and 7/15 (46.7%) of the complications were diagnosed in Boston Terrier. Healing occurred after one treatment in 299/308 (97.1%) eyes, and the remaining cases needed a second treatment.
CONCLUSIONS
CTD + SBD + SGK is an inexpensive and efficient treatment for SCCED in dogs. Boston Terrier may be at higher risk of developing complications following this procedure.
Topics: Animals; Chronic Disease; Corneal Diseases; Debridement; Dogs; Epithelium, Corneal; Female; Male; Retrospective Studies; Surgical Instruments; Treatment Outcome
PubMed: 33085183
DOI: 10.1111/vop.12838