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Wounds : a Compendium of Clinical... Aug 2023CAMPs are used for treating refractory DFUs where other treatments have failed. PLA is a CAMP that has demonstrated effectiveness in promoting healing in burns and acute... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
CAMPs are used for treating refractory DFUs where other treatments have failed. PLA is a CAMP that has demonstrated effectiveness in promoting healing in burns and acute wounds.
OBJECTIVE
A single-center, prospective, randomized controlled trial comparing PLA-guided closure matrices versus collagen dressings was conducted to assess healing of Wagner grades 1 and 2 DFUs.
MATERIALS AND METHODS
A total of 30 participants were randomized to receive weekly debridement, wound care, and DFU offloading plus either PLA or collagen CAMPs. The primary outcome was the time to achieve full healing, and the secondary outcome was the proportion of ulcers healed at 12 weeks.
RESULTS
The median time to achieve full healing was 9.3 ± 2.9 weeks in the PLA group versus 14.8 ± 8.1 weeks in the collagen group (P = .021), representing a 44% reduction in the time to heal. Furthermore, by 12 weeks, 80% of the PLA-treated ulcers were healed compared to only 33% in the collagen group (P = .025).
CONCLUSION
The results of this study show PLA matrices induce a potent healing response that leads to reduced healing time and an increased OR for achieving healing by 12 weeks.
Topics: Humans; Diabetes Mellitus; Diabetic Foot; Polyesters; Prospective Studies; Debridement
PubMed: 37643451
DOI: 10.25270/wnds/23094 -
Wounds : a Compendium of Clinical... Dec 2023Most chronic wounds contain biofilm, and debridement remains the centerpiece of treatment. Enzymatic debridement is an effective tool in removing nonviable tissue,...
An open-label, proof-of-concept study assessing the effects of bromelain-based enzymatic debridement on biofilm and microbial loads in patients with venous leg ulcers and diabetic foot ulcers.
BACKGROUND
Most chronic wounds contain biofilm, and debridement remains the centerpiece of treatment. Enzymatic debridement is an effective tool in removing nonviable tissue, however, there is little evidence supporting its effect on planktonic and biofilm bacteria.
OBJECTIVE
This study evaluated the effects of a novel BBD agent on removal of nonviable tissue, biofilm, and microbial loads in patients with chronic ulcers.
MATERIALS AND METHODS
Twelve patients with DFU or VLU were treated with up to 8 once-daily applications of BBD and then followed for an additional 2 weeks. Punch biopsy specimens were collected and analyzed for biofilm, and fluorescence imaging was used to measure bacterial load.
RESULTS
Ten patients completed treatment, and 7 achieved complete debridement within a median of 2 applications (range, 2-8). By the end of the 2-week follow-up period, the mean ± SD reduction in wound area was 35% ± 38. In all 6 patients who were positive for biofilm at baseline, the biofilm was reduced to single individual or no detected microorganisms by the end of treatment. Red fluorescence for Staphylococcus aureus decreased from a mean of 1.09 cm² ± 0.58 before treatment to 0.39 cm² ± 0.25 after treatment. BBD was safe and well tolerated.
CONCLUSION
Preliminary data suggest that BBD is safe and that it can be used to effectively debride DFU and VLU, reduce biofilm and planktonic bacterial load, and promote reduction in wound size.
Topics: Humans; Biofilms; Bromelains; Debridement; Diabetes Mellitus; Diabetic Foot; Wound Healing; Proof of Concept Study
PubMed: 38277629
DOI: 10.25270/wnds/23099 -
Journal of Sport and Health Science Mar 2023When non-operative management fails to improve symptoms in patients with non-insertional Achilles tendinopathy, surgery may be required. Various open and endoscopic... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
When non-operative management fails to improve symptoms in patients with non-insertional Achilles tendinopathy, surgery may be required. Various open and endoscopic techniques have been proposed, and platelet-rich plasma (PRP) injections have been proposed as an adjunct to aid tendon healing.
METHODS
Thirty-six patients with mid-portion Achilles tendinopathy were randomized to undergo endoscopic debridement alone (n = 19) or in combination with intraoperative PRP application (n = 17). Clinical outcome measures included the Visual Analogue Scale for pain, function, and satisfaction and the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire. Patients were followed-up at 6 weeks, 3 months, 6 months, and 12 months after surgery. An MRI examination at 3 and 12 months was used to assess signal alterations within the tendon.
RESULTS
Both groups showed significant clinical improvement (p < 0.05) after surgery, with no difference between the 2 groups. Tendon diameter increased at 3 months and decreased at 12 months. The tendinopathy area increased at 3 months and decreased at 12 months below baseline level in both groups. There was no significant difference between the groups regarding the MRI parameters. Nodular thickening and MRI-detected signal alteration persisted after surgery, with no association between imaging and clinical outcome. Five minor complications were reported: 2 in the PRP group and 3 in the control group.
CONCLUSION
Endoscopic debridement of the Achilles tendon improved clinical outcomes in patients with mid-portion tendinopathy. The addition of PRP did not improve outcomes compared to debridement alone. MRI parameters showed no association with clinical outcomes.
Topics: Humans; Achilles Tendon; Debridement; Tendinopathy; Platelet-Rich Plasma; Musculoskeletal Diseases
PubMed: 32619656
DOI: 10.1016/j.jshs.2020.06.012 -
Medicine Dec 2023The purpose of this study is to verify whether early stage patients with single-segment lumbar Brucella spondylitis can still be cured through simple posterior fixation...
The purpose of this study is to verify whether early stage patients with single-segment lumbar Brucella spondylitis can still be cured through simple posterior fixation and bone grafting, even without debridement. A retrospective study was conducted on 63 patients diagnosed with single-segment lumbar brucellosis spondylitis, who underwent posterior-only debridement (or not), bone grafting, and instrumentation from June 2016 to June 2019. Group A comprised 34 patients who did not undergo debridement, while group B comprised 29 patients who underwent debridement. The clinical data and imaging results of the patients were compared between the 2 groups to evaluate the clinical effects of debridement or not. Both groups of patients completed at least 1 year of follow-up. The group A had significantly lower values for operation time, blood loss, and hospital stay compared to the group B (P < .05). There were no significant differences between the 2 groups in terms of erythrocyte sedimentation rate, C-reactive protein, visual analogue scores, improvement of Japanese Orthopaedic Association Evaluation of treatment score, and Cobb angle. The bone fusion rate was 92% (31 patients) in group A and 96% (28 patients) in group B, with no significant difference between the 2 groups (P > .05). In summary, these findings suggest that posterior fixation and bone graft fusion are effective treatments for single-segment lumbar brucellosis spondylitis in early stages even without debridement. Importantly, these procedures offer several benefits, such as minimal trauma, short operation times, rapid postoperative recovery, and favorable bone graft fusion outcomes.
Topics: Humans; Tuberculosis, Spinal; Bone Transplantation; Retrospective Studies; Spinal Fusion; Lumbar Vertebrae; Thoracic Vertebrae; Debridement; Spondylitis; Brucellosis; Treatment Outcome
PubMed: 38115351
DOI: 10.1097/MD.0000000000036577 -
Archives of Orthopaedic and Trauma... Jul 2023In acute periprosthetic knee infections, debridement and implant retention (DAIR) is the preferred treatment prior to one- and two-stage revisions. The aim of this study...
INTRODUCTION
In acute periprosthetic knee infections, debridement and implant retention (DAIR) is the preferred treatment prior to one- and two-stage revisions. The aim of this study is to compare the outcomes of arthroscopic and open debridement of infected primary total knee arthroplasties (TKA).
MATERIAL AND METHODS
We analyzed clinical, laboratory, and antibiotic treatment data, collected in patients with periprosthetic knee infection treated with DAIR at a Swiss Level 1 orthopedic and trauma center over a 10-year period between January 2005 and May 2015. Inclusion criteria were primary total knee arthroplasty and early postoperative or acute hematogenous periprosthetic joint infection (PJI). The primary endpoint was the need for further revision surgery due to persistent infection. The secondary endpoint was the prosthesis salvage in further infection surgeries.
RESULTS
Forty-two patients with 44 acute or hematogenous periprosthetic knee infections were included. We recorded 20 recurrent infections (45%) in our study population: 10 (77%) out of 13 in the arthroscopic DAIR group and 10 (32%) out of 31 in the open DAIR group. Two-stage revision, meaning complete removal of the TKA, insertion of a spacer and replantation at a second stage, had to be performed in three patients treated initially arthroscopically (23%) and in six patients treated initially with an open surgical procedure (21%).
CONCLUSIONS
Open debridement for acute periprosthetic knee infection shows clear benefits in terms of infection eradication and prosthesis salvage compared to arthroscopic DAIR.
Topics: Humans; Debridement; Prosthesis-Related Infections; Retrospective Studies; Treatment Outcome; Knee Joint; Anti-Bacterial Agents
PubMed: 36735051
DOI: 10.1007/s00402-023-04782-5 -
BMC Ophthalmology Apr 2021To evaluate the effects of lid debris debridement and meibomian gland expression (MGX) on extracellular matrix metalloproteinase-9 (MMP-9) levels and clinical outcomes...
Effects of lid debris debridement combined with meibomian gland expression on the ocular surface MMP-9 levels and clinical outcomes in moderate and severe meibomian gland dysfunction.
BACKGROUND
To evaluate the effects of lid debris debridement and meibomian gland expression (MGX) on extracellular matrix metalloproteinase-9 (MMP-9) levels and clinical outcomes of moderate and severe MGD.
METHODS
In this retrospective case series study, a total 48 eyes of 24 patients with moderate and severe MGD underwent one session of lid debris debridement using the BlephEx combined with MGX. We evaluated the tear film break-up time (TBUT), corneal and conjunctival fluorescein staining scores, Schirmer 1 test, biomicroscopic examination of lid margins and meibomian gland (MG), ocular surface disease index (OSDI) questionnaire score, and extracellular MMP-9 levels using a point-of-care MMP-9 immunoassay device before and 4 weeks after lid debris debridement and MGX. Linear mixed model and generalized estimating equations model were used to evaluate possible differences.
RESULTS
There were significant improvements in the TBUT (P = 0.002), SICCA and Oxford staining scores (all P < 0.001), lid margin telangiectasia (P < 0.001 for upper and lower eyelids), lid thickness (P < 0.001 for upper and lower eyelids), MG orifice plugging (P < 0.001 for upper and lower eyelids), meibum color (P = 0.026 for upper eyelid, P < 0.001 for lower eyelid), meibum consistency (P < 0.001 for upper and lower eyelids), meibum grade (P < 0.001), MGD stage (P < 0.001), and OSDI score (P = 0.002). MMP-9 immunoassay positivity rate significantly decreased from 83.3 to 50.0% 4 weeks after treatment (P = 0.014).
CONCLUSIONS
In patients with moderate to severe MGD, lid debris debridement using the BlephEx combined with MGX improved clinical findings, subjective symptoms, meibomian gland function, along with ocular surface MMP-9 level. We hereby suggest lid debris debridement using BlephEx combined with MGX as an effective clinical strategy for treatment of moderate to severe MGD.
Topics: Debridement; Eyelid Diseases; Humans; Matrix Metalloproteinase 9; Meibomian Gland Dysfunction; Meibomian Glands; Retrospective Studies; Tears
PubMed: 33845799
DOI: 10.1186/s12886-021-01926-2 -
International Journal of Dental Hygiene Feb 2023Debridement methods may damage implant surfaces. This in vitro study investigated eight debridement protocols across three implant surfaces to assess both biofilm...
OBJECTIVES
Debridement methods may damage implant surfaces. This in vitro study investigated eight debridement protocols across three implant surfaces to assess both biofilm removal and surface alterations.
MATERIAL AND METHODS
One hundred sixty commercially pure titanium discs were treated to simulate commercially available titanium implant surfaces-smooth, abraded and abraded and etched. Following inoculation with whole human saliva to create a mixed species biofilm, the surfaces were treated with eight debridement methods currently used for clinical peri-implantitis (n = 10). This included air abrasion using powders of glycine, sodium bicarbonate and calcium carbonate; conventional mechanical methods-piezoelectric scaler, carbon and stainless steel scalers; and a chemical protocol using 40% citric acid. Following treatment, remaining biofilm was analysed using scanning electron microscopy and crystal violet assays. For statistical analysis, ANOVA was applied (p < 0.05).
RESULTS
All debridement techniques resulted in greater than 80% reduction in biofilm compared with baseline, irrespective of the surface type. Glycine powder delivered through an air polishing system eliminated the most biofilm. Mechanical instruments were the least effective at eliminating biofilm across all surfaces and caused the greatest surface alterations. Citric acid was comparable with mechanical debridement instruments in terms of biofilm removal efficacy. Titanium surfaces were least affected by air abrasion protocols and most affected by mechanical methods.
CONCLUSIONS
Mechanical protocols for non-surgical debridement should be approached with caution. Glycine powder in an air polisher and 40% citric acid application both gave minimal alterations across all implant surfaces, with glycine the superior method in terms of biofilm removal.
Topics: Humans; Dental Implants; Titanium; Debridement; Powders; Air Abrasion, Dental; Surface Properties; Biofilms; Microscopy, Electron, Scanning; Glycine
PubMed: 35943293
DOI: 10.1111/idh.12616 -
Medicine Mar 2021Knee Osteoarthritis (KOA) is a degenerative osteoarthrosis with knee joint pain as the main symptom. In recent years, arthroscopic removal of loose body and repair of...
The effectiveness of traditional Chinese medicine fumigation and washing nursing care after arthroscopic debridement of Knee Osteoarthritis: A protocol for systematic review and meta-analysis.
BACKGROUND
Knee Osteoarthritis (KOA) is a degenerative osteoarthrosis with knee joint pain as the main symptom. In recent years, arthroscopic removal of loose body and repair of meniscus have become common methods for the treatment of KOA. However, postoperative pain, swelling and limited joint movement affect the functional recovery of knee joint and the effect of surgical treatment. Early postoperative control of pain and swelling is of great significance to improve the curative effect of arthroscopic debridement and promote the recovery of knee joint function. In recent years, many clinical studies have reported that the nursing method of fumigation and washing with Chinese medicine after arthroscopic debridement of KOA can relieve pain, promote the recovery of joint function and improve the clinical curative effect, but there is a lack of evidence-based medicine. The purpose of this study is to evaluate the efficacy and safety of fumigation and washing with traditional Chinese medicine after KOA arthroscopy.
METHODS
Computer retrieval English database (PubMed, Embase, Web of Science, the Cochrane Library) and Chinese database (China National Knowledge Infrastructure, Wanfang, VIP Database for Chinese Technical Periodicals, China Biology Medicine disc), moreover manual retrieval academic, Google and baidu from building to since December 2020, traditional Chinese medicine fumigation applied to KOA arthroscopy postoperative nursing of randomized controlled clinical research, by two researchers independently evaluated the quality of the included study and extracted the data. Meta-analysis of the included literatures was performed using RevMan5.3 software.
RESULTS
The main observation index of this study was the effective rate, and the secondary indexes included Visual Analogue Scale Score, the Western Ontario and McMaster university orthopedic index, Lysholms score and adverse reactions, so as to evaluate the efficacy and safety of traditional Chinese medicine fumigation nursing after KOA arthroscopy.
CONCLUSION
This study will provide reliable evidence for the clinical application of Fumigation and washing nursing of traditional Chinese medicine after KOA arthroscopy.
ETHICS AND DISSEMINATION
Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval will not be required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences.
OSF REGISTRATION NUMBER
DOI 10.17605/OSF.IO/THZP4.
Topics: Arthroscopy; Debridement; Drugs, Chinese Herbal; Fumigation; Humans; Medicine, Chinese Traditional; Meta-Analysis as Topic; Osteoarthritis, Knee; Postoperative Care; Postoperative Complications; Randomized Controlled Trials as Topic; Research Design; Systematic Reviews as Topic; Treatment Outcome
PubMed: 33725941
DOI: 10.1097/MD.0000000000024752 -
BMC Musculoskeletal Disorders Jun 2022This is a retrospective study. (Review)
Review
A comparative study of one-stage posterior unilateral limited laminectomy vs. bilateral laminectomy debridement and bone grafting fusion combined with internal fixation for the treatment of aged patients with single-segment spinal tuberculosis.
STUDY DESIGN
This is a retrospective study.
BACKGROUND
To assess and compare the clinical outcomes of posterior unilateral limited laminectomy (ULL) or bilateral laminectomy (BL) debridement and bone grafting fusion combined with internal fixation among aged patients with single-segment thoracic and lumbar tuberculosis (SST/LTB).
MATERIALS AND METHODS
We performed a retrospective study on aged patients (age > 65 years old) with SST/LTB from January 2010 to October 2018. We reviewed 36 aged patients who were treated with BL and 31 aged patients treated with ULL. All participants had undergone and finished a three-year follow-up. The outcomes were evaluated by the improvement of neurological function, correction Cobb angle, bone fusion time, and back pain, as well as operative time, blood loss, hospital stay, and postoperative complications.
RESULTS
The operative time, blood loss volume, and incidence of complications in group B were significantly less than those in group A (P < 0.01). The postoperative kyphotic angle in both groups was reduced significantly compared to the preoperative status (P < 0.01). The percentage of neurological improvement was 92.9% in group A and 90.9% in group B. All patients achieved solid bone fusion after surgery. At three-year follow-up, the angle loss in group B was significantly less than that in group A (P < 0.01); Furthermore, patients in group B had a lower average visual analog scale score of back pain and Oswestry Disability Index score than patients in group A (P < 0.05).
CONCLUSIONS
For aged patients with SST/LTB, ULL is a safer and more effective surgical treatment than BL.
Topics: Aged; Bone Transplantation; Debridement; Humans; Laminectomy; Lumbar Vertebrae; Postoperative Complications; Retrospective Studies; Spinal Fusion; Thoracic Vertebrae; Treatment Outcome; Tuberculosis, Spinal
PubMed: 35761205
DOI: 10.1186/s12891-022-05562-9 -
Alternative Therapies in Health and... Jul 2022The aim of this study was to attempt to evaluate the effect of fibular osteotomy (FO) with joint debridement compared with arthroscopic debridement in terms of the... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The aim of this study was to attempt to evaluate the effect of fibular osteotomy (FO) with joint debridement compared with arthroscopic debridement in terms of the degree of pain and range of motion in patients with knee osteoarthritis (KOA).
METHODS
From August 2018 to February 2020, our hospital admitted 88 patients with KOA to this prospective study. They were randomly divided into 2 groups: the FO group (44 patients) received an FO with joint debridement and the control group (44 patients) were given simple arthroscopic debridement. Detailed data regarding clinical symptoms, knee joint function and degree of pain were collected and recorded before and 3 and 6 months after surgery in order to compare the patients' quality of life (QoL), related nerve injury, delayed union, wound infection and other complications in the 2 groups.
RESULTS
No significant difference were found regarding pre-operative clinical symptoms in the 2 groups (P > .05). However, 3 months and 6 months after surgery, the clinical symptoms in the FO group were highly associated with lower outcomes compared with the control group (P < .05). Although there were no significant differences in terms of knee function, degree of pain or QoL between the 2 groups before surgery (P > .05), there was a superior beneficial effect on the above symptoms observed in the FO group compared with the control group at 3 and 6 months. In this study, no complications such as nerve injury, delayed healing or wound infection occurred in either group.
CONCLUSION
The significant improvements in terms of clinical symptoms, pain and range of motion were observed following FO with joint debridement in patients with KOA. Hence, this approach may be valid for broad clinical application.
Topics: Arthroscopy; Debridement; Humans; Osteoarthritis, Knee; Osteotomy; Pain; Prospective Studies; Quality of Life; Range of Motion, Articular; Treatment Outcome; Wound Infection
PubMed: 35452415
DOI: No ID Found