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Advances in Wound Care Dec 2022Diabetic foot ulcerations have devastating complications, including amputations, poor quality of life, and life-threatening infections. Diabetic wounds can be... (Review)
Review
Diabetic foot ulcerations have devastating complications, including amputations, poor quality of life, and life-threatening infections. Diabetic wounds can be protracted, take significant time to heal, and can recur after healing. They are costly consuming health care resources. These consequences have serious public health and clinical implications. Debridement is often used as a standard of care. Debridement consists of both nonmechanical (autolytic, enzymatic) and mechanical methods (sharp/surgical, wet to dry debridement, aqueous high-pressure lavage, ultrasound, and biosurgery/maggot debridement therapy). It is used to remove nonviable tissue, to facilitate wound healing, and help prevent these serious outcomes. What are the various forms and rationale behind debridement? This article comprehensively reviews cutting-edge methods and the science behind debridement and diabetic foot ulcers.
Topics: Debridement; Diabetes Mellitus; Diabetic Foot; Foot Ulcer; Humans; Quality of Life; Wound Healing
PubMed: 34376065
DOI: 10.1089/wound.2021.0016 -
Advances in Skin & Wound Care Apr 2021To present the 2021 update of the Wound Bed Preparation paradigm.
GENERAL PURPOSE
To present the 2021 update of the Wound Bed Preparation paradigm.
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. Apply wound assessment strategies. 2. Identify patient concerns about wound care. 3. Select management options for healable, nonhealable, and maintenance wounds.
Topics: Debridement; Education, Continuing; Humans; Wound Healing; Wounds and Injuries
PubMed: 33739948
DOI: 10.1097/01.ASW.0000733724.87630.d6 -
Wounds : a Compendium of Clinical... Jun 2022Wound care professionals face complex challenges in their attempts to achieve healing in patients with a diabetic foot ulcer (DFU).1 Peripheral neuropathy limits...
Wound care professionals face complex challenges in their attempts to achieve healing in patients with a diabetic foot ulcer (DFU).1 Peripheral neuropathy limits sensation, which necessitates consistent offloading of the DFU site. Peripheral arterial, venous, or lymphatic circulation disorders must be diagnosed and addressed. Early diagnosis and management of soft tissue or bone infection is required. Chronic kidney disease, glycemic control, and nutritional needs must be addressed along with counterproductive behavior patterns.2 The use of topical hydrocolloid-based hydrogel dressings3 or honey4 on DFUs facilitates moist wound healing and debridement. Randomized controlled trials (RCTs) indicate that carefully controlling all of these factors helps optimize outcomes for individuals with a DFU. Promising phase 2 clinical studies with stringent inclusion criteria and rigorously applied diagnostic and management procedures are rarely replicated in larger phase 3 RCTs with broader inclusion criteria and less rigorously applied DFU management procedures. Narrow RCT inclusion criteria can limit study applicability for the general DFU population. This installment of Evidence Corner reviews 2 RCTs that use different approaches to address these issues. The first RCT reports interim results of a new autologous skin construct applied to Wagner grade 1 DFUs.5 The second compares the effects of standard wound dressings (SWDs) vs negative pressure wound therapy (NPWT) applied to Wagner grade 2, 3, or 4 DFU according to standard protocols during real-world clinical practice in German patients.6.
Topics: Bandages; Debridement; Diabetes Mellitus; Diabetic Foot; Humans; Negative-Pressure Wound Therapy; Wound Healing
PubMed: 35881427
DOI: 10.25270/wnds/2022.175177 -
Plastic and Reconstructive Surgery Aug 2021After studying this article, the participant should be able to: 1. Understand the basics of biofilm infection and be able to distinguish between planktonic and biofilm... (Review)
Review
LEARNING OBJECTIVES
After studying this article, the participant should be able to: 1. Understand the basics of biofilm infection and be able to distinguish between planktonic and biofilm modes of growth. 2. Have a working knowledge of conventional and emerging antibiofilm therapies and their modes of action as they pertain to wound care. 3. Understand the challenges associated with testing and marketing antibiofilm strategies and the context within which these strategies may have effective value.
SUMMARY
The Centers for Disease Control and Prevention estimate for human infectious diseases caused by bacteria with a biofilm phenotype is 65 percent and the National Institutes of Health estimate is closer to 80 percent. Biofilms are hostile microbial aggregates because, within their polymeric matrix cocoons, they are protected from antimicrobial therapy and attack from host defenses. Biofilm-infected wounds, even when closed, show functional deficits such as deficient extracellular matrix and impaired barrier function, which are likely to cause wound recidivism. The management of invasive wound infection often includes systemic antimicrobial therapy in combination with débridement of wounds to a healthy tissue bed as determined by the surgeon who has no way of visualizing the biofilm. The exceedingly high incidence of false-negative cultures for bacteria in a biofilm state leads to missed diagnoses of wound infection. The use of topical and parenteral antimicrobial therapy without wound débridement have had limited impact on decreasing biofilm infection, which remains a major problem in wound care. Current claims to manage wound biofilm infection rest on limited early-stage data. In most cases, such data originate from limited experimental systems that lack host immune defense. In making decisions on the choice of commercial products to manage wound biofilm infection, it is important to critically appreciate the mechanism of action and significance of the relevant experimental system. In this work, the authors critically review different categories of antibiofilm products, with emphasis on their strengths and limitations as evident from the published literature.
Topics: Anti-Bacterial Agents; Bacteria; Biofilms; Debridement; Humans; Treatment Outcome; Wound Healing; Wound Infection
PubMed: 34398099
DOI: 10.1097/PRS.0000000000008142 -
Medicina (Kaunas, Lithuania) Oct 2019Diabetic foot ulcers (DFUs) are the fastest growing chronic complication of diabetes mellitus, with more than 400 million people diagnosed globally, and the condition is... (Review)
Review
Diabetic foot ulcers (DFUs) are the fastest growing chronic complication of diabetes mellitus, with more than 400 million people diagnosed globally, and the condition is responsible for lower extremity amputation in 85% of people affected, leading to high-cost hospital care and increased mortality risk. Neuropathy and peripheral arterial disease trigger deformities or trauma, and aggravating factors such as infection and edema are the etiological factors for the development of DFUs. DFUs require identifying the etiology and assessing the co-morbidities to provide the correct therapeutic approach, essential to reducing lower-extremity amputation risk. This review focuses on the current treatment strategies for DFUs with a special emphasis on tissue engineering techniques and regenerative medicine that collectively target all components of chronic wound pathology.
Topics: Debridement; Diabetes Complications; Diabetes Mellitus; Diabetic Foot; Humans; Laser Therapy; Peripheral Nervous System Diseases; Skin Diseases
PubMed: 31731539
DOI: 10.3390/medicina55110714 -
Burns : Journal of the International... Jun 2020Bromelain-based Enzymatic Debridement has been introduced as an additional concept to the burn surgeon's armamentarium and is best indicated for mid-to deep dermal burns...
INTRODUCTION
Bromelain-based Enzymatic Debridement has been introduced as an additional concept to the burn surgeon's armamentarium and is best indicated for mid-to deep dermal burns with mixed patterns. Increasing evidence has been published focusing on special regions and settings as well as on limitations of Enzymatic Debridement to improve patient care. To better guide Enzymatic Debridement in view of the increasing experience, there is a need to update the formerly published consensus guidelines with user-orientated recommendations, which were last produced in 2017.
METHODS
A multi-professional expert panel of plastic surgeons and burn care specialists from twelve European centers was convened, to assist in developing current recommendations for best practices with use of Enzymatic Debridement. Consensus statements were based on peer-reviewed publications and clinical relevance, and topics for re-evaluation and refinement were derived from the formerly published European guidelines. For consensus agreement, the methodology employed was an agreement algorithm based on a modification of the Willy and Stellar method. For this study on Enzymatic Debridement, consensus was considered when there was at least 80 % agreement to each statement.
RESULTS
The updated consensus guidelines from 2019 refer to the clinical experience and practice patterns of 1232 summarized patient cases treated by the panelists with ED in Europe (2017: 500 cases), reflecting the impact of the published recommendations. Forty-three statements were formulated, addressing the following topics: indications, pain management and anesthesia, large surface treatment, timing of application for various indications, preparation and application, post-interventional wound management, skin grafting, outcome, scar and revision management, cost-effectiveness, patient´s perspective, logistic aspects and training strategies. The degree of consensus was remarkably high, with consensus in 42 out of 43 statements (97.7%). A classification with regard to timing of application for Enzymatic Debridement was introduced, discriminating immediate/very early (≤12 h), early (12-72 h) or delayed (>72 h) treatment. All further recommendations are addressed in the publication.
CONCLUSIONS
The updated guidelines in this publication represent further refinement of the recommended indication, application and post-interventional management for the use of ED. The published statements contain detailed, user-orientated recommendations aiming to align current and future users and prevent pitfalls, e.g. for the successful implementation of ED in further countries like the USA. The significance of this work is reflected by the magnitude of patient experience behind it, larger than the total number of patients treated in all published ED clinical trials.
Topics: Bandages; Body Surface Area; Bromelains; Burns; Debridement; Europe; Humans; Practice Guidelines as Topic; Skin Transplantation; Time Factors; Wound Healing
PubMed: 32241591
DOI: 10.1016/j.burns.2020.03.002 -
Journal of Wound Care Mar 2020
Topics: Anti-Infective Agents; Anti-Infective Agents, Local; Bandages; Biofilms; Debridement; Detergents; Early Medical Intervention; Humans; Pain Management; Practice Guidelines as Topic; Skin; Surface-Active Agents; Treatment Failure; Wound Healing; Wounds and Injuries
PubMed: 32160083
DOI: 10.12968/jowc.2020.29.Sup3b.S1 -
World Journal of Emergency Surgery :... Mar 2023To determine the efficacy of hyperbaric oxygen therapy (HBO) in the treatment of necrotizing soft tissue infections (NSTI), we conducted a meta-analysis of the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
To determine the efficacy of hyperbaric oxygen therapy (HBO) in the treatment of necrotizing soft tissue infections (NSTI), we conducted a meta-analysis of the available evidence.
METHODS
Data sources were PubMed, Embase, Web of Science, Cochrane Library, and reference lists. The study included observational trials that compared HBO with non-HBO, or standard care. The primary outcome was the mortality rate. Secondary outcomes were the number of debridement, amputation rate and complication rate. Relative risks or standardized mean differences with 95% confidence intervals were calculated for dichotomous and continuous outcomes, respectively.
RESULTS
A total of retrospective cohort and case-control studies were included, including 49,152 patients, 1448 who received HBO and 47,704 in control. The mortality rate in the HBO group was significantly lower than that in the non-HBO group [RR = 0.522, 95% CI (0.403, 0.677), p < 0.05]. However, the number of debridements performed in the HBO group was higher than in the non-HBO group [SMD = 0.611, 95% CI (0.012, 1.211), p < 0.05]. There was no significant difference in amputation rates between the two groups [RR = 0.836, 95% CI (0.619, 1.129), p > 0.05]. In terms of complications, the incidence of MODS was lower in the HBO group than in the non-HBO group [RR = 0.205, 95% CI (0.164, 0.256), p < 0.05]. There was no significant difference in the incidence of other complications, such as sepsis, shock, myocardial infarction, pulmonary embolism, and pneumonia, between the two groups (p > 0.05).
CONCLUSION
The current evidence suggests that the use of HBO in the treatment of NSTI can significantly reduce the mortality rates and the incidence rates of complications. However, due to the retrospective nature of the studies, the evidence is weak, and further research is needed to establish its efficacy. It is also important to note that HBO is not available in all hospitals, and its use should be carefully considered based on the patient's individual circumstances. Additionally, it is still worthwhile to stress the significance of promptly evaluating surgical risks to prevent missing the optimal treatment time.
Topics: Humans; Soft Tissue Infections; Hyperbaric Oxygenation; Retrospective Studies; Debridement; Combined Modality Therapy
PubMed: 36966323
DOI: 10.1186/s13017-023-00490-y -
Ugeskrift For Laeger Feb 2022Crocodile bites are one of the most powerful bites of any creature. Bite wounds are usually deep, with severe tissue damage, frequently contaminated with unusual...
Crocodile bites are one of the most powerful bites of any creature. Bite wounds are usually deep, with severe tissue damage, frequently contaminated with unusual microorganisms, and are difficult to treat. This case report describes the treatment of a middle-aged man admitted after a crocodile attack to the left distal end of humerus, elbow and proximal forearm. He was successfully treated with empirical broad-spectrum antibiotics and repeated wound debridement. The patient was discharged after nine days of intensive care at a level 1 trauma unit, good outcomes were seen eight months later.
Topics: Alligators and Crocodiles; Animals; Anti-Bacterial Agents; Bites and Stings; Debridement; Elbow Joint; Humans; Male; Middle Aged
PubMed: 35179117
DOI: No ID Found -
Tidsskrift For Den Norske Laegeforening... Feb 2024Necrotising soft tissue infections can affect the skin, subcutaneous tissue, superficial fascia, deep fascia and musculature. The infections are severe, they spread... (Review)
Review
Necrotising soft tissue infections can affect the skin, subcutaneous tissue, superficial fascia, deep fascia and musculature. The infections are severe, they spread quickly and can result in extensive tissue loss. Although rare, morbidity and mortality rates are high. Early clinical identification is crucial for the outcome, and rapid infection control through surgery and targeted antibiotic treatment is needed to save lives. Few prospective clinical trials have been conducted for the treatment of this type of infection. Specific challenges include rapid identification of the condition and the uncertain efficacy of the various treatment options. In this clinical review article, we describe clinical characteristics, diagnostics and treatment.
Topics: Humans; Soft Tissue Infections; Fasciitis, Necrotizing; Prospective Studies; Debridement; Anti-Bacterial Agents
PubMed: 38415568
DOI: 10.4045/tidsskr.23.0720