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principles of debridement

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https://www.readbyqxmd.com/read/28501719/colliding-jets-provide-depth-control-for-water-jetting-in-bone-tissue
#1
S den Dunnen, J Dankelman, G M Kerkhoffs, G Tuijthof
In orthopaedic surgery, water jet drilling provides several advantages over classic drilling with rigid drilling bits, such as the always sharp cut, absence of thermal damage and increased manoeuvrability. Previous research showed that the heterogeneity of bone tissue can cause variation in drilling depth whilst water jet drilling. To improve control over the drilling depth, a new method is tested consisting of two water jets that collide directly below the bone surface. The expected working principle is that after collision the jets will disintegrate, with the result of eliminating the destructive power of the coherent jets and leaving the bone tissue underneath the focal point intact...
May 6, 2017: Journal of the Mechanical Behavior of Biomedical Materials
https://www.readbyqxmd.com/read/28443251/partial-heel-pad-avulsion-with-open-calcaneal-tuberosity-fracture-with-tendo-achilles-rupture-a-case-report
#2
Shameem Ahmed, Syed Ifthekar, R Pathan Rameez Ahmed Khan, Rahul Ranjan
INTRODUCTION: The management of heel pad avulsion injuries has been challenging because of the precarious blood supply. The difficulties get compounded when it is associated with tendo-achilles rupture and calcaneal fracture. Here, it is a description of a case with the above features managed with a unique technique. CASE REPORT: A 63-year-old woman presented to casualty with injury to right ankle after a road traffic accident. On clinical and radiological examination, there was avulsion of heel pad with calcaneal tuberosity fracture and tendo-achilles rupture...
September 2016: Journal of Orthopaedic Case Reports
https://www.readbyqxmd.com/read/28396930/initial-management-of-complex-hand-injuries-in-military-or-austere-environments-how-to-defer-and-prepare-for-definitive-repair
#3
Camille Choufani, Olivier Barbier, Antoine Grosset, James Charles Murison, Didier Ollat, Sylvain Rigal, Laurent Mathieu
INTRODUCTION: The damage control orthopedics (DCO) concept is a sequential surgical management strategy indicated when ideal primary treatment is not possible or suitable. DCO principles are routinely applied to hand traumas in wartime practice, but could also be useful in a civilian setting when immediate specialized management cannot be carried out. METHODS: The authors report three typical observations of soldiers treated for a complex hand trauma on the field by orthopedic surgeons from the French Military Health Service (FMHS)...
April 10, 2017: International Orthopaedics
https://www.readbyqxmd.com/read/28381378/severe-acute-pancreatitis-pathogenesis-diagnosis-and-surgical-management
#4
Mark Portelli, Christopher David Jones
BACKGROUND: Severe acute pancreatitis is a subtype of acute pancreatitis, associated with multiple organ failure and systemic inflammatory response syndrome. In this qualitative review we looked at the principles of pathogenesis, classification and surgical management of severe acute pancreatitis. We also looked at the current shift in paradigm in the management of severe acute pancreatitis since the guideline developed by the British Society of Gastroenterology. DATA SOURCES: Studies published between 1st January 1991 and 31st December 2015 were identified with PubMed, MEDLINE, EMBASE and Google Scholar online search engines using the following Medical Subject Headings: "acute pancreatitis, necrosis, mortality, pathogenesis, incidence" and the terms "open necrosectomy and minimally invasive necrosectomy"...
April 2017: Hepatobiliary & Pancreatic Diseases International: HBPD INT
https://www.readbyqxmd.com/read/28375805/management-and-novel-adjuncts-of-necrotizing-soft-tissue-infections
#5
REVIEW
Christine S Cocanour, Phillip Chang, Jared M Huston, Charles A Adams, Jose J Diaz, Charles B Wessel, Bonnie A Falcione, Graciela M Bauza, Raquel A Forsythe, Matthew R Rosengart
Necrotizing soft tissue infections (NSTI) have been recognized for millennia and continue to impose considerable burden on both patient and society in terms of morbidity, death, and the allocation of resources. With improvements in the delivery of critical care, outcomes have improved, although disease-specific therapies are lacking. The basic principles of early diagnosis, of prompt and broad antimicrobial therapy, and of aggressive debridement have remained unchanged. Clearly novel and new therapeutics are needed to combat this persistently lethal disease...
April 2017: Surgical Infections
https://www.readbyqxmd.com/read/28328683/surgical-support-during-the-terrorist-attacks-in-paris-november-13-2015-experience-at-b%C3%A3-gin-military-teaching-hospital
#6
Olivier Barbier, Brice Malgras, Camille Choufani, Antoine Bouchard, Didier Ollat, Gilbert Versier
BACKGROUND: Recent conflicts have allowed the French Army Health Service to improve management quality for wartime-injured people during military operations. On November 13, 2015, it was in Paris that France was directly attacked and Bégin Military Teaching Hospital, like several hospitals in Paris, had to face a large number of gunshot victims. Thanks to our operational experience, injured people hospitalized in military hospitals benefited from a management based on triage and damage control (DC) principles...
June 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28264136/phototherapeutic-keratectomy-science-and-art
#7
Steven E Wilson, Gustavo K Marino, Carla S Medeiros, Marcony R Santhiago
PURPOSE: To describe, with videos, the principles of excimer laser phototherapeutic keratectomy (PTK) for the treatment of corneal scars, corneal surface irregularity, and recurrent corneal erosions. METHODS: Depending on the pathology in a treated cornea, the epithelium is removed either by transepithelial PTK ablation with the excimer laser or thorough scraping with a scalpel blade. Stromal PTK can be performed with or without photorefractive keratectomy (PRK), depending on the refractive status of both eyes...
March 1, 2017: Journal of Refractive Surgery
https://www.readbyqxmd.com/read/28260266/burns-dressings
#8
Helen E Douglas, Fiona Wood
BACKGROUND: Burn injuries are common and costly; each year, there are more than 200,000 cases, costing the Australian community $150 million. Management of smaller burn injuries in the community can be improved by appropriate first aid, good burn dressings and wound management. This can reduce the risk of the burn becoming deeper or infected, and can potentially reduce the requirement for specialist review or surgery. OBJECTIVE: The objective of this article is to provide healthcare professionals with information about the pathophysiology of burn wound progression...
March 2017: Australian Family Physician
https://www.readbyqxmd.com/read/27922956/the-complicated-facial-war-injury-pitfalls-and-mismanagement
#9
Ghassan S Abu-Sittah, Joe Baroud, Christopher Hakim, Cynthia Wakil
OBJECTIVE: The aim of this paper is to share the authors' experience in the management of complicated facial war injuries using free tissue transfer. A discussion on the most commonly encountered pitfalls in management during the acute and complicated settings is presented in an effort to raise insight on facial war wound complications. METHODOLOGY: Two patients of complicated facial war injuries are presented to exemplify the pitfalls in acute and chronic management of the mandibular region in the first patient and the orbito-maxillary region in the second...
January 2017: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/27922787/hydro-responsive-wound-dressings-simplify-t-i-m-e-wound-management-framework
#10
REVIEW
Karen Ousey, Alan A Rogers, Mark G Rippon
The development of wound management protocols and guidelines such as the T.I.M.E. acronym are useful tools to aid wound care practitioners deliver effective wound care. The tissue, infection/inflammation, moisture balance and edge of wound (T.I.M.E.) framework provides a systematic approach for the assessment and management of the majority of acute and chronic wounds. The debridement of devitalised tissue from the wound bed, the reduction in wound bioburden and effective management of wound exudate - i.e., wound bed preparation - are barriers to wound healing progression that are targeted by T...
December 2016: British Journal of Community Nursing
https://www.readbyqxmd.com/read/27893924/deciding-how-best-to-treat-cartilage-defects
#11
Lucy Oliver-Welsh, Justin W Griffin, Maximilian A Meyer, Matthew E Gitelis, Brian J Cole
The decision-making regarding and treatment of cartilage abnormalities requires a systematic approach. This article reviews the concepts and principles that guide the management of this complex problem. The precise incidence, demographics, and progression of cartilage lesions have not been clearly delineated. Pursuing a patient-centered approach that considers the available nonsurgical and surgical options remains the cornerstone of patient care. The importance of determining concomitant knee pathologies, the proper interpretation and implications of imaging findings, and an accurate determination of the intra-articular and subchondral findings represent the primary elements of the decision analysis...
November 1, 2016: Orthopedics
https://www.readbyqxmd.com/read/27846027/new-technique-acute-minced-expansion-graft-of-traumatic-wound-tissue
#12
Andrew Mark Klapper, Scott Moradian, Philip Pack
OBJECTIVES: Superficial soft tissue injury, such as a skin tear, is common. For such wounds, the authors introduce a novel technique that allows the physician to salvage otherwise discarded tissue as a traumatic graft to highly accelerate wound healing. METHODS: A series of 11 patients with superficial soft tissue trauma in which debrided tissues are salvaged back into the wound by means of minced expansion grafting (MEG) are followed from presentation through healing...
December 2016: Advances in Skin & Wound Care
https://www.readbyqxmd.com/read/27749625/gastric-perforation-after-a-dog-attack
#13
Hayaki Uchino, Akira Kuriyama, John Bruce, Grant Laing, Damian Clarke, George Oosthuizen
Dog bites are a major cause of injury, especially in the pediatric population. Common anatomic sites of dog bites on children are the peripheries and the head and neck. The torso is reportedly injured less frequently, and only 2 cases of intra-abdominal injury secondary to dog bites have been reported. We recently encountered a 3-year-old boy presenting with peritonitis who had sustained multiple dog bites to his trunk and upper limbs. Emergency laparotomy was performed. Surgical findings revealed penetration of the peritoneum and single perforation of the anterior gastric wall with multiple tooth marks; thus, the gastric perforation was debrided and repaired...
September 30, 2016: Pediatric Emergency Care
https://www.readbyqxmd.com/read/27711086/fournier-s-gangrene-a-clinical-review
#14
REVIEW
Ariana Singh, Kamran Ahmed, Abdullatif Aydin, Muhammad Shamim Khan, Prokar Dasgupta
INTRODUCTION AND HYPOTHESIS: Fournier's gangrene is a rare, necrotising fasciitis of the external genitalia, perineal or perianal regions. The disease has a higher incidence in males and risk factors for development include diabetes, HIV, alcoholism and other immune-compromised states. The aggressive disease process is associated with a high mortality rate of 20-30%. In addition, the increasing age and prevalence of diabetes in the population, begs the need for increased clinical awareness of Fournier's gangrene with emphasis on early diagnosis and management...
October 5, 2016: Archivio Italiano di Urologia, Andrologia
https://www.readbyqxmd.com/read/27703940/salvage-of-a-below-knee-amputation-utilizing-rotationplasty-principles-in-a-patient-with-chronic-tibial-osteomyelitis
#15
Matthew R Moralle, Nicholas D Stekas, Mark C Reilly, Michael S Sirkin, Mark R Adams
INTRODUCTION: Chronic osteomyelitis is a disease that requires fastidious treatment to eliminate. However, when eradication is unable to be achieved through exhaustive modalities of antibiotic therapy and multiple debridements, significant resection of the infected bone and soft tissue must be considered, including amputation. Here we report of a salvage procedure for chronic osteomyelitis of the left tibia by employing a rotationplasty to avoid an above knee amputation and instead provide the patient with a below knee amputation...
April 2016: Journal of Orthopaedic Case Reports
https://www.readbyqxmd.com/read/27680011/-wound-management-with-enzyme-alginogels-expert-consensus
#16
REVIEW
R Strohal, B Assenheimer, M Augustin, G Hämmerle, S Läuchli, B Pundt, G Stern, M Storck, C Ulrich
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...
September 28, 2016: Der Hautarzt; Zeitschrift Für Dermatologie, Venerologie, und Verwandte Gebiete
https://www.readbyqxmd.com/read/27665246/in-view-of-standardization-part-2-management-of-challenges-in-the-initial-treatment-of-burn-patients-in-burn-centers-in-germany-austria-and-switzerland
#17
Benjamin Ziegler, Christoph Hirche, Johannes Horter, Jurij Kiefer, Paul Alfred Grützner, Thomas Kremer, Ulrich Kneser, Matthias Münzberg
INTRODUCTION: Initial therapy of severe burns in specialized burn trauma centers is a challenging task faced by the treating multi-professional and interdisciplinary team. A lack of consistent operating procedures and varying structural conditions was recently demonstrated in preliminary data of our group. These results raised the question on how specific treatment measures in acute burn care are met in the absence of standardized guidelines. MATERIAL AND METHODS: A specific questionnaire containing 57 multiple-choice questions was sent to all 22 major burn centers in Germany, Austria and Switzerland...
March 2017: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/27661426/debridement-and-irrigation-evolution-and-current-recommendations
#18
Nicholas J Erdle, Eric G Verwiebe, Joseph C Wenke, Christopher S Smith
Debridement is an integral step in the orthopaedic management of traumatic wounds, from open soft tissue injuries and routine open fracture care to the management of extensive high-energy blast injuries. While the necessity of debridement has been well established, the level of energy and degree of contamination of blast wounds encountered in recent armed conflict has offered a challenge and a new opportunity for military surgeons to revisit the most recent literature to guide our practice with the best evidence currently available...
October 2016: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/27556779/current-concepts-in-debridement-science-and-strategies
#19
REVIEW
Ersilia L Anghel, Michael V DeFazio, Jenny C Barker, Jeffrey E Janis, Christopher E Attinger
BACKGROUND: The establishment of a healthy wound bed through adequate debridement of infected, senescent, and/or devitalized tissue is central to the progression of normal wound healing. Although a variety of surgical and nonsurgical strategies have been proposed, none have proven completely effective in all settings. This review focuses on the principles and techniques of modern debridement practices employed in the management of complex wounds. METHODS: A comprehensive review of the PubMed/Medline and Ovid databases was performed to identify basic science and clinical studies using key words most relevant to biofilm, debridement, and wound healing...
September 2016: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/27550045/-infected-osteosynthesis
#20
O Borens, N Helmy
BACKGROUND: Infections after osteosynthesis are a feared complication of the surgical treatment of fractures and should be dealt with by a multidisciplinary team. In addition to the surgeon, also included in this multidisciplinary team are a specialist for infectious diseases, a microbiologist, a radiologist and often a plastic surgeon. This review article describes the current knowledge on the pathogenesis, diagnostics, classification and treatment. The aim is to demonstrate some basic rules in the treatment of infections associated with implants and to show potential therpeutic approaches...
October 2016: Der Chirurg; Zeitschrift Für Alle Gebiete der Operativen Medizen
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