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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 -
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 -
American Journal of Rhinology & Allergy 2012The modern rhinologist has a wide variety of technological innovations at his/her disposal for the removal of soft tissue and bone during endoscopic surgery. We... (Review)
Review
BACKGROUND
The modern rhinologist has a wide variety of technological innovations at his/her disposal for the removal of soft tissue and bone during endoscopic surgery. We identified and critically evaluated four leading tissue removal technologies that have impacted, or are poised to impact, rhinological surgery.
METHODS
A literature review was conducted.
RESULTS
Technological functions, strengths and limitations of microdebriders, radio frequency ablation, endoscopic drills, and ultrasonic aspirators were explored. The primary drawback of powered instruments continues to be the higher costs associated with their use, and their main advantage is the ability to accomplish multiple functions such as tissue removal, suction, and irrigation, all with one tool. The effective and safe use of any powered instrument requires an intimate understanding of its function, capabilities, and limitations.
CONCLUSION
Powered instrumentation continues to play a significant and evolving role in soft tissue and bone removal during rhinologic surgery.
Topics: Catheter Ablation; Debridement; Endoscopy; Health Care Costs; Humans; Nasal Cavity; Otorhinolaryngologic Surgical Procedures; Surgical Equipment; Ultrasonic Surgical Procedures
PubMed: 22391085
DOI: 10.2500/ajra.2012.26.3722 -
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 -
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 -
Orthopaedic Surgery Oct 2021To compare the effects of arthroscopic debridement and repair in treating Ellman grade II bursal-side partial-thickness rotator cuff tears. (Comparative Study)
Comparative Study Randomized Controlled Trial
Comparison of Arthroscopic Debridement and Repair in the Treatment of Ellman Grade II Bursal-side Partial-thickness Rotator Cuff Tears: A Prospective Randomized Controlled Trial.
OBJECTIVE
To compare the effects of arthroscopic debridement and repair in treating Ellman grade II bursal-side partial-thickness rotator cuff tears.
METHODS
This is a single-center, prospective, randomized controlled trial. From September 2017 to April 2019, 78 patients underwent arthroscopic debridement (35 patients) or repair (43 patients) due to Ellman grade II bursal-side partial-thickness rotator cuff tears. Twenty-six men and 52 women were included in the study, with an average age of 56.31 years (range, 42 to 74 years). After the acromioplasty was formed, the debridement group only performed stump refreshing and surrounding soft tissue cleaning, while the repair group converted the partial tears into full-thickness tears and then sutured them by single row or suture bridge technique. The visual analogue scale (VAS), Constant-Murley shoulder (CMS), American Shoulder and Elbow Surgeons (ASES), and University of California, Los Angeles (UCLA) scores were used to evaluate clinical results preoperatively and at 6, 12, and 18 months postoperatively. Magnetic resonance imaging was used to assess the integrity of the rotator cuff, muscle atrophy, and fat infiltration.
RESULTS
A total of 85 patients met the inclusion criteria and were randomly divided into the debridement group (41 patients) and the repair group (43 patients). During the 18-month follow-up period, a total of seven patients were lost to follow-up. The functional scores of both groups were significantly improved: the VAS score decreased 5.06 and 4.63 in the debridement group (5.77 preoperative to 0.71 postoperative) and the repair group (5.49 to 0.86) (P < 0.05). Moreover, the CMS, ASES, UCLA scores increased 51.63, 58.24, 20.57 in debridement group (39.46 to 91.09, 34.14 to 92.38, 13.29 to 33.86), and increased 48.14, 60.53, 20.93 in repair group (43.63 to 91.77, 33.10 to 93.63, 12.58 to 33.51) (P < 0.05). No significant differences were found in functional scores between the two groups at 6, 12, and 18 months postoperatively (P > 0.05). The magnetic resonance imaging showed no re-tears, and no difference was observed in the degree of muscle atrophy and fat infiltration between the two groups (P > 0.05). Except for four cases of shoulder stiffness, no other obvious surgery-related complications were found.
CONCLUSION
For Ellman grade II bursal-side partial-thickness rotator cuff tears, both the debridement and repair groups achieved good results during 18-month follow-ups, with no difference between the two groups.
Topics: Adult; Aged; Arthroscopy; Debridement; Double-Blind Method; Female; Humans; Male; Middle Aged; Pain Measurement; Prospective Studies; Rotator Cuff Injuries; Surveys and Questionnaires
PubMed: 34596965
DOI: 10.1111/os.13130 -
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 Surgery Jul 2017Spinal brucellosis is a less commonly reported infectious spinal pathology. There are few reports regarding the surgical treatment of spinal brucellosis in existing...
BACKGROUND
Spinal brucellosis is a less commonly reported infectious spinal pathology. There are few reports regarding the surgical treatment of spinal brucellosis in existing literature. This retrospective study was conducted to determine the effectiveness of single-stage transforaminal decompression, debridement, interbody fusion, and posterior instrumentation for lumbosacral spinal brucellosis.
METHODS
From February 2012 to April 2015, 32 consecutive patients (19 males and 13 females, mean age 53.7 ± 8.7) with lumbosacral brucellosis treated by transforaminal decompression, debridement, interbody fusion, and posterior instrumentation were enrolled. Medical records, imaging studies, laboratory data were collected and summarized. Surgical outcomes were evaluated based on visual analogue scale (VAS), Oswestry Disability Index (ODI) and Japanese Orthopaedic Association (JOA) scale. The changes in C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), clinical symptoms and complications were investigated. Graft fusion was evaluated using Bridwell grading criteria.
RESULTS
The mean follow-up period was 24.9 ± 8.2 months. Back pain and radiating leg pain was relieved significantly in all patients after operation. No implant failures were observed in any patients. Wound infection was observed in two patients and sinus formation was observed in one patient. Solid bony fusion was achieved in 30 patients and the fusion rate was 93.8%. The levels of ESR and CRP were returned to normal by the end of three months' follow-up. VAS and ODI scores were significantly improved (P < 0.05). According to JOA score, surgical improvement was excellent in 22 cases (68.8%), good in 9 cases (28.1%), moderate in 1 case (3.1%) at the last follow-up.
CONCLUSIONS
Single-stage transforaminal decompression, debridement, interbody fusion, and posterior instrumentation is an effective and safe approach for lumbosacral brucellosis.
Topics: Adult; Aged; Back Pain; Brucellosis; Debridement; Decompression, Surgical; Female; Humans; Lumbosacral Region; Male; Middle Aged; Retrospective Studies; Spinal Fusion
PubMed: 28705257
DOI: 10.1186/s12893-017-0279-x -
Burns : Journal of the International... Sep 2023Removal of necrotic tissue is a vital step in the treatment of full-thickness burn wounds, with surgical debridement being the most effective method. Since minor burn...
INTRODUCTION
Removal of necrotic tissue is a vital step in the treatment of full-thickness burn wounds, with surgical debridement being the most effective method. Since minor burn wounds are typically treated on an outpatient basis where surgical capabilities can be limited there is a need for alternative treatment options. In this study we aim to evaluate the use of amino acid buffered hypochlorite (AABH) as a chemical enhancement for wound debridement in a porcine infected burn wound model.
METHOD
A total of 60 full-thickness burn wounds, 3 cm in diameter, were created on four pigs using a standardized burn device. The wounds were inoculated with 10 colony-forming units (CFU) of S. aureus. The experimental groups included wounds debrided with a plastic curette, wounds debrided after pretreatment with AABH, and control wounds wiped with gauze. Wounds were treated twice per week for three weeks. Debridement, healing, and infection parameters were evaluated over time.
RESULTS
After one week, but not after two and three weeks, the curette and AABH groups had higher debrided weights compared to control (p < 0.05). Percentage of wound area adequately cleared from necrotic tissue was higher in the AABH-group compared to the curette-group and control, after one week. The earliest healing was measured in the AABH group after two weeks (5 % of wounds), which also had the most healed wounds after three weeks (55 %). In both the AABH and the curette groups, bacterial load had fallen below 10 CFU/g after two weeks. No CFU were detectable in the AABH group after three weeks. The AABH-group was also the easiest to debride.
CONCLUSION
Our results indicate that AABH facilitates wound debridement and could be a helpful addition to an effective treatment modality for removal of necrotic tissue in full-thickness burns.
Topics: Animals; Swine; Burns; Debridement; Hypochlorous Acid; Staphylococcus aureus; Amino Acids; Wound Infection; Soft Tissue Injuries
PubMed: 36543728
DOI: 10.1016/j.burns.2022.11.011