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Medicine Sep 2021To describe the retroperitoneoscopic debridement technique and evaluate the clinical outcome of internal fixation for the treatment of lumbar tuberculosis.Twenty-eight...
To describe the retroperitoneoscopic debridement technique and evaluate the clinical outcome of internal fixation for the treatment of lumbar tuberculosis.Twenty-eight patients were performed conventional laparoendoscopic technique (n = 17) or laparoendoscopic single-site technique (n = 11). Antituberculosis chemotherapy and thoracolumbosacral orthosis were given to all patients. The clinical outcomes were evaluated with preoperative and postoperative Visual Analog Scale, and radiographs with respect to sagittal angle and fusion status.Average time of the 28 procedures was 220.6 ± 50.9 min (180-365 min). The average intraoperative blood loss was 108.6 ± 95.3 mL (50-400 mL). All patients showed significant improvement of their Visual Analog Scale back pain score at follow-up and were classified as having a radiographic fusion in this study. The mean sagittal angle was 11.2 ± 3.6° before operation, significantly improved to 3.7 ± 2.4° after operation. There were no recurrent infections during the follow-up period. Complications included loosening of anterior fixation and temporary deficit of the sympathetic nerve.Retroperitoneal laparoscopic approach with CO2 insufflation technique is a challenging but safe and effective procedure for lumbar spine tuberculosis. Retroperitoneal laparoendoscopic single-site can be used for anterior lumbar spine surgery, offer exposure for L1 through L5.
Topics: Adult; Aged; Debridement; Female; Humans; Internal Fixators; Lumbosacral Region; Male; Middle Aged; Retroperitoneal Space; Retrospective Studies; Treatment Outcome; Tuberculosis, Osteoarticular
PubMed: 34664848
DOI: 10.1097/MD.0000000000027198 -
Journal of Comparative Effectiveness... Feb 2018Chronic dermal ulcers affect approximately 2.4-4.5 million people in the USA and are associated with loss of function, decreased quality of life and significant... (Comparative Study)
Comparative Study Meta-Analysis Review
Chronic dermal ulcers affect approximately 2.4-4.5 million people in the USA and are associated with loss of function, decreased quality of life and significant economic burden. Debridement is a critical component of wound care involving removal of nonviable tissue from chronic wounds to stimulate the granulation and epithelialization process. Clostridial collagenase ointment has been used as a method of wound debridement for more than 50 years and is currently the only enzymatic debriding ointment with US FDA approval. This review discusses the results of recent real-world studies that build upon the evidence demonstrating the clinical effectiveness, cost-effectiveness and safety of clostridial collagenase ointment across wound types and care settings.
Topics: Chronic Disease; Cost-Benefit Analysis; Debridement; Epidemiologic Methods; Humans; Microbial Collagenase; Ointments; Quality of Life; Skin Ulcer; Treatment Outcome; Wound Healing
PubMed: 29076747
DOI: 10.2217/cer-2017-0066 -
The Journal of Medical Investigation :... 2020Objective : Infectious spondylodiscitis (IS) is rarely seen in healthy elementary school age children. Conservative treatment with antibiotics is usually preferable... (Review)
Review
Objective : Infectious spondylodiscitis (IS) is rarely seen in healthy elementary school age children. Conservative treatment with antibiotics is usually preferable but sometimes fails because of the low identification rate of the pathogen by percutaneous needle biopsy. When surgical treatment is indicated, selecting the appropriate procedure is crucial in terms of invasiveness for such young children. Case report : We present the case of a 9-year-old otherwise healthy girl with IS who successfully underwent debridement and identification of the causative pathogen using full endoscopic discectomy (FED) system. Methicillin-susceptible Staphylococcus aureus was identified on several cultures of samples. Immediately after the surgery, the LBP was significantly decreased and the remittent fever resolved dramatically. At the 1-year follow-up, she had no symptoms and plain radiographs showed bony fusion. Conclusion : This is the first report on IS in elementary school-age children treated with the FED system. Debridement using this system could provide minimally invasive and effective curettage of the infected disc space and can be helpful in identifying the pathogen even for small children. J. Med. Invest. 67 : 351-354, August, 2020.
Topics: Child; Debridement; Discitis; Diskectomy; Endoscopy; Female; Humans; Lumbar Vertebrae
PubMed: 33148914
DOI: 10.2152/jmi.67.351 -
Wound Management & Prevention Aug 2021Wound cleansing is an important component of wound management.
Effect of Mechanical Debridement and Irrigation With Hypochlorous Acid Wound Management Solution on Methicillin-resistant Staphylococcus aureus Contamination and Healing Deep Dermal Wounds in a Porcine Model.
BACKGROUND
Wound cleansing is an important component of wound management.
PURPOSE
This study was conducted to examine the effect of a wound management solution (WMS) containing hypochlorous acid (HOCl) on methicillin-resistant Staphylococcus aureus (MRSA) and healing when used in conjunction with debridement.
METHODS
Nineteen (19) deep reticular dermal wounds (22 mm × 22 mm × 3 mm deep) were created on the paravertebral and thoracic areas of 3 female pigs using a specialized electrokeratome. Wounds were separated by at least 5 cm to 7 cm of unwounded skin and inoculated with MRSA. After 72 hours, all wounds were debrided with a curette and irrigated with either the WMS or sterile saline solution twice per day from day 0 to day 4. Wounds then were irrigated once a day until the completion of the study (day 11). Wound tissue specimens were taken using punch biopsy for microbiological and histological analysis on days 4, 8, and 11 post treatment. Percent of wound epithelialized, epithelial thickness (cell layers µm), white cell infiltrate (1 = absent, 2 = mild, 3 = moderate, 4 = marked, 5 = exuberant), and percent of granulation tissue formation were calculated and assessed. Microbiology and histology results were analyzed for significant differences between treatments and among assessment days using one-way analysis of variance and student t-tests. A P value ≤ .05 was considered significant.
RESULTS
The WMS effected a bacterial reduction (P ≤ .05) of more than 2.74 ± 0.43 and 1.03 ± 0.22 Log CFU/g in all assessment days compared with baseline before and after debridement, respectively. Percent epithelialization was significantly different between treatments on day 8, only 78.3% and 67.8% for HOCl and saline, respectively (P ≤ .05). No significant differences between treatments were observed for epithelial thickness or granulation tissue formation.
CONCLUSION
The combination of debridement and HOCl wound irrigation can significantly reduce MRSA contamination and facilitate the healing process compared to saline irrigation. Clinical studies are needed to confirm these results.
Topics: Animals; Debridement; Female; Granulation Tissue; Hypochlorous Acid; Methicillin-Resistant Staphylococcus aureus; Swine; Wound Healing
PubMed: 34370678
DOI: No ID Found -
Orthopaedic Surgery Aug 2023There is considerable controversy regarding the optimal approach (open vs arthroscopic) of releasing and/or debridement for the treatment of tennis elbow (TE). The aim... (Meta-Analysis)
Meta-Analysis Review
There is considerable controversy regarding the optimal approach (open vs arthroscopic) of releasing and/or debridement for the treatment of tennis elbow (TE). The aim of this study was to determine the clinical outcomes of the two techniques by quantitatively synthesizing outcome data. The study was performed by searching the PubMed, EMBASE, Ovid, and Elsevier databases between January 1995 and April 2022 for a minimum follow-up of 6 months. The searching strategy was "(tennis elbow [Title/Abstract] OR lateral epicondylitis [Title/Abstract]) AND (open [Title/Abstract] OR arthroscopic [Title/Abstract] OR release [Title/Abstract] OR debridement [Title/Abstract] OR surgery [Title/Abstract])". The quality of each study was investigated using the Coleman Methodology Score. In total, 1411 (693 open, 718 arthroscopic) elbows in 1392 patients who underwent releasing and debridement for tennis elbow were identified. The mean Coleman Methodology Score for the included studies was 55.2 ± 8.6 (open: 55.0 ± 9.4, arthroscopic: 55.8 ± 8.2). Improved clinical results were achieved after treatment with either open or arthroscopic treatment. The surgical success rate was 95.6% in open surgery and 92.4% in arthroscopic management. The complication rates were 2.2% and 1.5% for open and arthroscopic procedures, respectively. Similar subjective and objective outcomes, and surgical success rate were observed in patients with both techniques. Patients who had undergone arthroscopic release seemed to return to work earlier (5.3 weeks vs 7.1 weeks). To draw more definite conclusions, high-quality long-term follow-up randomized controlled trials are needed.
Topics: Humans; Treatment Outcome; Tennis Elbow; Arthroscopy; Elbow Joint; Debridement
PubMed: 36444948
DOI: 10.1111/os.13570 -
International Wound Journal Apr 2021Chronic wounds are defined as "hard-to-heal" wounds that are caused by disordered mechanisms of wound healing. Chronic wounds have a high risk of infection and can form... (Review)
Review
Chronic wounds are defined as "hard-to-heal" wounds that are caused by disordered mechanisms of wound healing. Chronic wounds have a high risk of infection and can form biofilms, leading to the release of planktonic bacteria, which causes persistent infections locally or remotely. Therefore, infection control and removal of the biofilm in chronic wounds are essential. Recently, ultrasonic debridement was introduced as a new method to reduce infection and promote the healing of chronic wounds. This scoping review aimed to evaluate the effectiveness of ultrasonic debridement on the changes in bacteria and biofilms, and consequently the wound healing rate of chronic wounds. A total of 1021 articles were identified through the database search, and nine papers were eligible for inclusion. Findings suggest that non-contact devices are useful for wound healing as they reduce the inflammatory response, although the bacterial load is not significantly changed. Ultrasonic debridement devices that require direct contact with the wound promote wound healing through reduction of biofilm or bacterial load. The optimum settings for ultrasonic debridement using a non-contact device are relatively consistent, but the settings for devices that require direct contact are diverse. Further studies on ultrasonic debridement in chronic wounds are required.
Topics: Bacteria; Biofilms; Debridement; Humans; Ultrasonics
PubMed: 33236843
DOI: 10.1111/iwj.13509 -
Clinical Interventions in Aging 2009With our aging population, chronic diseases that compromise skin integrity such as diabetes, peripheral vascular disease (venous hypertension, arterial insufficiency)... (Review)
Review
With our aging population, chronic diseases that compromise skin integrity such as diabetes, peripheral vascular disease (venous hypertension, arterial insufficiency) are becoming increasingly common. Skin breakdown with ulcer and chronic wound formation is a frequent consequence of these diseases. Types of ulcers include pressure ulcers, vascular ulcers (arterial and venous hypertension), and neuropathic ulcers. Treatment of these ulcers involves recognizing the four stages of healing: coagulation, inflammation, proliferation, and maturation. Chronic wounds are frequently stalled in the inflammatory stage. Moving past the inflammation stage requires considering the bacterial burden, necrotic tissue, and moisture balance of the wound being treated. Bacterial overgrowth or infection needs to be treated with topical or systemic agents. In most cases, necrotic tissue needs to be debrided and moisture balance needs to be addressed by wetting dry tissue and drying wet tissue. Special dressings have been developed to accomplish these tasks. They include films, hydrocolloids, hydrogel dressings, foams, hydrofibers, composite and alginate dressings.
Topics: Aged; Bandages; Debridement; Female; Humans; Male; Middle Aged; Pressure Ulcer; Wound Healing
PubMed: 19554098
DOI: 10.2147/cia.s4726 -
Deutsches Arzteblatt International Apr 2012Osteomyelitis was described many years ago but is still incompletely understood. Its exogenously acquired form is likely to become more common as the population ages. We... (Review)
Review
BACKGROUND
Osteomyelitis was described many years ago but is still incompletely understood. Its exogenously acquired form is likely to become more common as the population ages. We discuss biofilm formation as a clinically relevant pathophysiological model and present current recommendations for the treatment of osteomyelitis.
METHODS
We selectively searched the PubMed and Cochrane databases for articles on the treatment of chronic osteomyelitis with local and systemic antibiotics and with surgery. The biofilm hypothesis is discussed in the light of the current literature.
RESULTS
There is still no consensus on either the definition of osteomyelitis or the criteria for its diagnosis. Most of the published studies cannot be compared with one another, and there is a lack of scientific evidence to guide treatment. The therapeutic recommendations are, therefore, based on the findings of individual studies and on current textbooks. There are two approaches to treatment, with either curative or palliative intent; surgery is now the most important treatment modality in both. In addition to surgery, antibiotics must also be given, with the choice of agent determined by the sensitivity spectrum of the pathogen.
CONCLUSION
Surgery combined with anti-infective chemotherapy leads to long-lasting containment of infection in 70% to 90% of cases. Suitable drugs are not yet available for the eradication of biofilm-producing bacteria.
Topics: Algorithms; Anti-Bacterial Agents; Bacterial Infections; Chronic Disease; Debridement; Humans; Osteomyelitis; Treatment Outcome
PubMed: 22536302
DOI: 10.3238/arztebl.2012.0257 -
Der Hautarzt; Zeitschrift Fur... Jan 2017The challenges of modern wound management, such as the treatment of chronic wounds and their phase-specific handling, are demanding and require optimally adapted... (Review)
Review
BACKGROUND
The challenges of modern wound management, such as the treatment of chronic wounds and their phase-specific handling, are demanding and require optimally adapted therapeutic measures. The principles of moist wound care as well as an adequate debridement have priority here. To support these necessary measures, different options are available, e.g., a new product group operating across several wound phases.
OBJECTIVE
A new treatment principle in modern wound management based on an expert consensus is presented.
METHODS
On the basis of clinical experience reports and published evidence, the current and new principles of wound treatment were discussed in a panel of experts and formulated as a consensus statement.
RESULTS
Enzyme alginogels represent a combination of agents that allow phase-specific wound care. They exhibit autolytic, absorbent, and antimicrobial properties and simultaneously cover three components of wound management based on the TIME framework. Thus, according to the experts, they differ from other wound healing products and can be classified in a distinct product group. Clinical studies, as well as clinical experiences, provide evidence for the efficacy of enzyme alginogels.
DISCUSSION
According to the experts, the potential of enzyme alginogels used considering the principles of moist wound care, comprises the three-fold effect (continuous and significantly simplified debridement, maintaining a moist wound environment and antimicrobial effect without cytotoxicity), the ease of use, and the flexible application. In addition, the flexibility of the product class regarding frequency of application, duration of treatment and combinability with secondary dressings, are of economic benefit in the health care sector.
Topics: Alginates; Anti-Bacterial Agents; Bandages; Combined Modality Therapy; Debridement; Dermatology; Evidence-Based Medicine; Expert Testimony; Germany; Humans; Lacerations; Oxidoreductases; Practice Guidelines as Topic; Treatment Outcome; Wound Healing
PubMed: 27680011
DOI: 10.1007/s00105-016-3878-z -
Journal of Plastic Surgery and Hand... May 2024The purpose of this article is to introduce a method that combines limited debridement and ReCell® autologous cell regeneration techniques for the treatment of deep...
BACKGROUND
The purpose of this article is to introduce a method that combines limited debridement and ReCell® autologous cell regeneration techniques for the treatment of deep second-degree burn wounds.
METHOD
A total of 20 patients suffered with deep second-degree burns less than 10% of total body surface area (TBSA) who were admitted to our department, from June 2019 to June 2021, participated in this study. These patients first underwent limited debridement with an electric/pneumatic dermatome, followed by the ReCell® technique for secondary wounds. Routine treatment was applied to prevent scarring after the wound healed. Clinical outcomes were scored using the Vancouver Scar Scale (VSS).
RESULTS
All wounds of the patients healed completely. One patient developed an infection in the skin graft area and finally recovered by routine dressing changes. The average healing time was 12 days (range: 10-15 days). The new skin in the treated area was soft and matched the colour of the surrounding normal skin and the VSS score ranged from 3~5 for each patient. Of the 20 patients, 19 were very satisfied and 1 was satisfied.
CONCLUSIONS
This article reports a useful treatment method that combines electric dermatome-dependent limited debridement and the ReCell® technique for the treatment of deep second-degree burn wounds. It is a feasible and effective strategy that is easy to implement and minimally invasive, and it is associated with a short healing time, mild scar formation and little damage to the donor skin area.
Topics: Humans; Burns; Debridement; Male; Adult; Female; Skin Transplantation; Middle Aged; Young Adult; Wound Healing; Cicatrix; Adolescent; Polyesters
PubMed: 38769787
DOI: 10.2340/jphs.v59.24557