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Wounds : a Compendium of Clinical... Oct 2021Chitosan has been proven to be helpful in wound care as a hemostatic agent. The hemostatic effect is due to the positively charged chitosan interacting with negatively...
INTRODUCTION
Chitosan has been proven to be helpful in wound care as a hemostatic agent. The hemostatic effect is due to the positively charged chitosan interacting with negatively charged red blood cell membranes, initiating the agglutination of red blood cells and platelets. This promotes the activation of thrombin, which activates the clotting pathway, leading to thrombus formation.
OBJECTIVE
Based on the properties of chitosan as a rapidly acting hemostatic agent, the authors sought to determine if a chitosan gelling fiber wound dressing could control bleeding of freshly debrided wounds. The effect of the chitosan dressing on overall healing and patient and provider satisfaction was also evaluated.
MATERIALS AND METHODS
Wounds of any etiology requiring sharp debridement in patients older than 18 years who were capable of consent were eligible. Wounds were sharply debrided by curettage, scalpel, electrosurgery, or a combination of methods. A chitosan dressing was applied to the freshly debrided wound with gentle pressure. The time from application to hemostasis as assessed by non-progression of blood pattern was measured. Other outcome measures also included digital photography, wound surface area, numerical pain scores, and Photographic Wound Assessment Tool (PWAT) scores. Patient and provider satisfaction were measured.
RESULTS
Twenty patients with a variety of etiologies and ulcer types were evaluated. After debridement, wound bleeding was rated as mild (n=9), moderate (n=9), or severe (n=2). The mean time to hemostasis was 75 seconds ± 41 SD (range, 28-221 seconds). In 1 week, the mean wound area decreased from 6.9 cm2 ± 7.8 to 6.2 cm2 ± 7.9 and mean PWAT scores decreased from 17.7 ± 4.9 to 11.4 ± 5.0 (lower score indicates wound healing). Pain scores associated with wound debridement were reduced in all but 1 patient evaluated at week 1. Overall, the rating scores from the Patient Reported Acceptance Questionnaire (PRAQ) and Provider Acceptance Questionnaire (PAQ) developed by this research group were high. The mean total PRAQ score was 30.5 ± 3.9 out of 35 (35 being most satisfied). The PAQ score was 15 out of 15 for all but 1 patient (15 being most satisfied).
CONCLUSIONS
The chitosan gelling fiber wound dressing was simple to use and rapidly promoted hemostasis in fresh sharply debrided wounds. It was safe and easy to use in an outpatient setting and was highly rated by the patients.
Topics: Chitosan; Debridement; Hemostasis; Hemostatics; Humans; Ulcer; Wound Healing
PubMed: 34735364
DOI: No ID Found -
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 -
Annals of Surgery Feb 2008To examine the surgical indications and clinical outcomes of a large cohort of patients with necrotizing pancreatitis. (Comparative Study)
Comparative Study
OBJECTIVE
To examine the surgical indications and clinical outcomes of a large cohort of patients with necrotizing pancreatitis.
SUMMARY BACKGROUND DATA
Mortality after debridement for necrotizing pancreatitis continues to be inordinately high. The clinical experience with patients who underwent uniform surgical treatment for necrotizing pancreatitis at the Massachusetts General Hospital over a 15-year period is described.
METHODS
Retrospective review of 167 patients with necrotizing pancreatitis who required intervention and were treated with single stage debridement and a closed packing technique. Particular emphasis was placed on the indication for surgery and the presence of infected necrosis. Multiple logistic regression models were used to identify predictors of mortality.
RESULTS
The primary preoperative indication for operation was infected necrosis (51%), but intraoperative cultures proved that 72% of the entire cohort was infected. The rate of reoperation was 12.6%, and 29.9% of patients required percutaneous interventional radiology drainage after initial debridement. Overall operative mortality was 11.4% (19/167), but higher in patients who were operated upon before 28 days (20.3% vs. 5.1%, P = 0.002). Other important predictors of mortality included organ failure > or =3 (OR = 2.4, P = 0.001), postoperative intensive care unit stay > or =6 days (OR = 15.9, P = 0.001), and female gender (OR = 5.41, P = 0.02).
CONCLUSIONS
Open, transperitoneal debridement followed by closed packing and drainage results in the lowest reported mortality and reoperation rates, and provides a standard for comparing other methods of treatment. A negative FNA does not reliably rule out infection. The clinical status of the patients and not proof of infection should determine the need for debridement.
Topics: Adult; Aged; Aged, 80 and over; Bacteria; Bacterial Infections; Debridement; Female; Follow-Up Studies; Humans; Length of Stay; Male; Massachusetts; Middle Aged; Pancreatitis, Acute Necrotizing; Retrospective Studies; Survival Rate; Time Factors; Treatment Outcome
PubMed: 18216536
DOI: 10.1097/SLA.0b013e31815b6976 -
Knee Surgery, Sports Traumatology,... Jan 2018Posterior elbow impingement can cause disabling pain and limited motion during activities involving elbow extension. Less understood is whether arthroscopic treatment,...
PURPOSE
Posterior elbow impingement can cause disabling pain and limited motion during activities involving elbow extension. Less understood is whether arthroscopic treatment, compared to open surgery, can result in effective management of pain, loss of range of motion, and return athletes to previous levels of activity. This study determined whether arthroscopic debridement is a safe and effective treatment for posterior elbow impingement and whether it enables athletes to return to a previous level of function.
METHODS
A retrospective review of 36 consecutive patients that underwent arthroscopic debridement of the posterior elbow was performed. There were 34 male and 2 female patients, with a median age of 32 years (17-54 years). There were 7 professional athletes, 6 college athletes, and 23 high school or recreational athletes. All patients had a positive posterior impingement test for posterior pain with extension and limitations of activity. Arthroscopic debridement and additional surgical procedures were performed, and patients underwent follow-up visits at a median 51 months (range 14-81).
RESULTS
Significant improvements were seen in pain, motion, and function. No neurovascular complications were seen related to the arthroscopic debridement. The mean Andrews and Timmerman elbow score improved from 159 ± 27 to 193 ± 11 (p < 0.01). Thirty-five of thirty-six (97%) patients returned to their previous level of activity, including all professional athletes.
CONCLUSIONS
Arthroscopic management of posterior elbow impingement is safe and effective and can return patients, including professional athletes, to high-level athletic activity. Athletes with symptomatic posterior elbow impingement can be successfully and safely treated with arthroscopic debridement and typically will return to preinjury levels of activity.
LEVEL OF EVIDENCE
IV.
Topics: Adolescent; Adult; Arthroscopy; Cumulative Trauma Disorders; Debridement; Elbow Joint; Female; Follow-Up Studies; Humans; Male; Middle Aged; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 28534159
DOI: 10.1007/s00167-017-4563-1 -
Medicine Nov 2019Previous studies have reported that both arthroscopic debridement (AD) and open debridement (OD) of extensor carpi radialis brevis are effective in the treatment of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Previous studies have reported that both arthroscopic debridement (AD) and open debridement (OD) of extensor carpi radialis brevis are effective in the treatment of lateral epicondylitis. Despite this, few studies have focused on the comparative outcomes of these 2 procedures. The aim of this study was to assess whether AD is superior to OD in managing lateral epicondylitis.
METHODS
A systematic search of the literature was conducted to identify relevant articles that were published in MEDLINE, Embase, and Cochrane Library databases during January 2019. All studies comparing the efficacy of AD and OD in terms of failure rate, complication rate, and clinical outcome measures were included. Statistical analysis was performed using Review Manager.
RESULTS
Six clinical trials were included in the current meta-analysis. There was no significant difference with regard to disabilities of the arm, shoulder, and hand scores, visual analog scale, and failure rate. There was a statistically significant difference in surgical time in favor of the OD (mean difference [MD], -11.45, 95% confidence interval [CI], -12.45 to -10.44, I = 0%, P < .001). There was no significant difference of complication rate between the OD group (0.6%) and the AD group (1.0%) (MD, 0.62; 95% CI, 0.12-3.06; P = .55) CONCLUSION:: There was no significant difference between arthroscopic and open surgery with regards to failure rate, functional outcome score, and complication rate. The current meta-analysis found that arthroscopic surgery had a longer surgical time than open surgery for lateral epicondylitis.
Topics: Arthroscopy; Debridement; Hand Strength; Humans; Operative Time; Postoperative Complications; Recovery of Function; Tennis Elbow; Visual Analog Scale
PubMed: 31689781
DOI: 10.1097/MD.0000000000017668 -
Journal of Orthopaedic Surgery and... Aug 2019Debridement and irrigation with prosthetic retention followed by antibiotic therapy (DAIR) is one of the treatments of choice in acute infections after a total knee...
BACKGROUND
Debridement and irrigation with prosthetic retention followed by antibiotic therapy (DAIR) is one of the treatments of choice in acute infections after a total knee arthroplasty. However, the success rate varies widely in the literature, depending on several factors such as comorbidities of the patient, duration of infection, and microorganisms involved. The goal of this study was to assess the outcomes of this therapeutic option and to identify possible predictors of the result.
METHODS
We retrospectively reviewed cases of acute postoperative (≤ 3 months from index procedure) and acute hematogenous periprosthetic knee infections treated with DAIR at our hospital between 2004 and 2016. Overall, 26 knees were included, with a mean age of 73.4 years. Several variables related to patient characteristics, infection type, and surgery were examined to evaluate their influence on outcome, and functional and radiographic outcome were assessed. The mean follow-up was 41 months. A descriptive analysis was carried out on the collected data, and a univariate analysis was performed with the objective of searching for influential factors in the resolution of the infection using the chi-square nonparametric test in the case of the categorical variables and the Wilcoxon test for the continuous ones. Moreover, univariate cox regression analysis was performed.
RESULTS
The overall success rate was 77% at the last follow-up, recording a significantly greater cure in acute infections (93% acute vs 58% acute hematogenous, p = 0.03). The infections in which the Staphylococcus aureus was isolated had a significantly lower cure rate, with only 33% of success, compared to 82% of the non-aureus microorganisms (p < 0.05).
CONCLUSIONS
The present study shows a considerable cure rate in the treatment of acute knee infections through DAIR, although patient comorbidities, type of infection, and causative microorganism should be considered for decision-making.
Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Arthroplasty, Replacement, Knee; Debridement; Female; Follow-Up Studies; Humans; Male; Middle Aged; Prosthesis Retention; Prosthesis-Related Infections; Treatment Outcome
PubMed: 31462250
DOI: 10.1186/s13018-019-1324-5 -
Journal of Periodontology Aug 2014This systematic review was requested by the Task Force of the American Academy of Periodontology as a follow-up study of the 2013 report, with an aim to investigate the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This systematic review was requested by the Task Force of the American Academy of Periodontology as a follow-up study of the 2013 report, with an aim to investigate the efficacy of different surgical approaches to treat peri-implantitis.
METHODS
A search of four electronic databases from January 1990 to May 2013 was performed. Studies included were human clinical trials published in English that applied surgeries for treating peri-implantitis. Parameters evaluated included probing depth (PD) reduction, clinical attachment level gain, bleeding on probing (BOP) reduction, radiographic bone fill (RBF), and mucosal recession. The weighted mean (WM) and the 95% confidence interval of the studied parameters were estimated with the random-effect model.
RESULTS
A total of 1,306 studies were initially identified, after reviewing titles, abstracts, and full texts, and 21 articles, 12 of which were case series, were finally included. Four treatment groups were identified: 1) access flap and debridement; 2) surgical resection; 3) application of bone grafting materials; and 4) guided bone regeneration. The mean initial PD ranged from 4.8 to 8.8 mm, with initial BOP ranging from 19.7% to 100%. Short-term follow-ups (3 to 63 months) revealed that the available surgical procedures yielded a WM PD reduction of 2.04 (group 2) to 3.16 mm (group 4), or 33.4% to 48.2% of the initial PD. The WM RBF was 2.1 mm for groups 3 and 4.
CONCLUSIONS
Within the limitation of this systematic review, the application of grafting materials and barrier membranes resulted in greater PD reduction and RBF, but there is a lack of high-quality comparative studies to support this statement. The results might be used to project treatment outcomes after surgical management of peri-implantitis.
Topics: Bone Substitutes; Debridement; Dental Etching; Guided Tissue Regeneration, Periodontal; Humans; Peri-Implantitis; Surgical Flaps; Treatment Outcome
PubMed: 24261909
DOI: 10.1902/jop.2013.130563 -
Medicine Oct 2022Seroma is the most common wound complication due to dead space remaining after mastectomy and axillary dissection. Seroma formation, which causes pain and tension,...
Successful use of minimal invasive debridement plus negative pressure wound therapy under skin flap and axillary region for refractory postmastectomy seroma: A STROBE-compliant retrospective study.
Seroma is the most common wound complication due to dead space remaining after mastectomy and axillary dissection. Seroma formation, which causes pain and tension, together with the limitations of shoulder and arm movements, can cause wound healing problems that can progress to wound dehiscence and flap necrosis. The aim of our study was to investigate the effects of continuous drainage and negative pressure wound therapy (NPWT) in breast cancer patients with refractory postmastectomy seroma. This retrospectively designed study was conducted with 27 patients who were referred to our center between 2018 and 2021 due to refractory seroma after mastectomy. The inclusion criteria of the study were the cases who were planned minimally invasive debridement and NPWT due to having refractory seroma formation with at least 200 cc and having interventions more than 1 month after modified radical mastectomy (MRM), despite conventional treatment methods. All patients' demographics, disease stage, history of possible neoadjuvant therapy, comorbidities, body mass index (BMI), number of wound dressings with NPWT, and total amount of NPWT accumulation were enrolled and compared statistically. Twenty-seven patients included in the study underwent continuous drainage after debridement, and 5 (3-9) dressings were treated with NPWT. None of the patients experienced complications after debridement and NPWT administration. In refractory seroma cases seen after postmastectomy, NPWT especially for the management of debridement and dead space can be evaluated as an appropriate treatment method in patients with high flow rate seroma.
Topics: Female; Humans; Breast Neoplasms; Debridement; Mastectomy; Negative-Pressure Wound Therapy; Postoperative Complications; Retrospective Studies; Seroma; Skin; Axilla; Surgical Flaps; Drainage
PubMed: 36316850
DOI: 10.1097/MD.0000000000031634 -
Journal of Orthopaedic Surgery and... Oct 2017Surgery treatment is usually required for spinal tuberculosis. The aim of this study was to compare the clinical efficacy and outcomes of anterior and posterior surgical... (Comparative Study)
Comparative Study
BACKGROUND
Surgery treatment is usually required for spinal tuberculosis. The aim of this study was to compare the clinical efficacy and outcomes of anterior and posterior surgical approach in combination with debridement, bone grafting, and internal fixation.
METHODS
All patients with thoracic and lumbar tuberculosis who underwent either the anterior or posterior surgery in combination with debridement, bone grafting, and internal fixation from August 2009 to August 2016 were reviewed retrospectively.
RESULTS
A total of 186 patients were recruited in the analyses, 37 of whom received the anterior approach and 149 treated with the posterior approach. In the entire study population, there was no statistically significant difference between the groups in terms of kyphosis Cobb's angle, VAS pain score, neurological status, operation duration, perioperative blood loss, and hospitalization days (p > 0.05). Good clinical outcomes were achieved in both treatment groups. In lumbar vertebra-affected patients, the average preoperative kyphosis Cobb's angle was 8.7 ± 16.6° and - 5.6 ± 16.0° for the anterior and posterior groups, respectively, which were corrected to - 3.3 ± 13.2° and - 10.1 ± 13.8° after surgery. For thoracic vertebra-affected patients, the corrected kyphosis Cobb's angle was 8.1 ± 9.7° and 10.3 ± 6.5°, respectively. After surgery, 32.4% of patients in the anterior group and 48.3% of patients in the posterior group claimed no pain (p = 0.24), while 83.8 and 85.9% recovered to Frankel grade E, respectively (p = 0.85).
CONCLUSIONS
The posterior debridement joint bone graft and internal fixation is an alternative procedure to treat lumbar and thoracic tuberculosis compared to the traditional anterior approach with similar clinical efficacy in terms of pain control, Cobb's angle, and neurological function. The posterior approach is sufficient for lesion debridement.
Topics: Adult; Aged; Bone Transplantation; Combined Modality Therapy; Debridement; Female; Humans; Internal Fixators; Lumbar Vertebrae; Male; Middle Aged; Patient Positioning; Thoracic Vertebrae; Tuberculosis, Spinal
PubMed: 29037194
DOI: 10.1186/s13018-017-0650-8 -
Annals of Surgery Nov 1998To evaluate the results of débridement and closed packing for necrotizing pancreatitis and to determine the optimal timing of surgical intervention based on patient... (Clinical Trial)
Clinical Trial
OBJECTIVE
To evaluate the results of débridement and closed packing for necrotizing pancreatitis and to determine the optimal timing of surgical intervention based on patient outcomes.
METHODS
Between February 1990 and November 1996, 64 consecutive patients with necrotizing pancreatitis were treated with necrosectomy followed by closed packing of the cavity with stuffed Penrose and closed suction drains. The mean APACHE II score immediately before surgery was 9, and 31% of the patients had organ failure. Patients were stratified with an outcome score based on death and major complications; this was correlated with the timing of surgical intervention. The data were then subjected to cut-point analysis by sequential group comparison.
RESULTS
Patients underwent surgery a median of 31 days after diagnosis. Fifty-six percent had infected necrosis. The mortality rate was 6.2% and was no different in infected or sterile necrosis. Eleven patients required a second surgical procedure and 13 required percutaneous drainage; a single surgical procedure sufficed in 69%. Enteric fistulae occurred in 16% of patients. The mean hospital stay after surgery was 41 days, and the interval until return to regular activities was 147 days. A significant negative correlation between duration of pancreatitis and outcome scores was found, and sequential group comparison demonstrated that the change point at which significantly better outcomes were encountered was day 27.
CONCLUSION
Débridement of pancreatic necrosis followed by closed packing and drainage is accomplished with a low mortality rate and reduced rates of complications and second surgical procedures. Although intervention is best deferred until the demarcation of necrosis is complete, delay beyond the fourth week confers no additional advantage.
Topics: APACHE; Adult; Aged; Aged, 80 and over; Debridement; Digestive System Surgical Procedures; Female; Humans; Male; Middle Aged; Pancreatitis, Acute Necrotizing; Postoperative Complications; Survival Rate
PubMed: 9833806
DOI: 10.1097/00000658-199811000-00007