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principles of debridement

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https://www.readbyqxmd.com/read/29590411/wartime-soft-tissue-coverage-techniques-for-the-deployed-surgeon
#1
Vilas Saldanha, Nathan Tiedeken, Brandon Godfrey, Nichole Ingalls
Background: Since the start of the conflict in the Middle East in 2001, military orthopedic surgeons have faced complex orthopedic injuries including high-energy soft tissue wounds, traumatic amputations, and open fractures. Although orthopedic surgeons are well trained in the management of osseous injuries, the treatment of soft tissue injuries can be technically challenging and unfamiliar. Early washout, debridement of devitalized tissue, external fixation of bony injuries, and antibiotic therapy remain the foundation of early wound management...
March 26, 2018: Military Medicine
https://www.readbyqxmd.com/read/29555119/the-principles-and-practice-of-open-fracture-care-2018
#2
Amna Diwan, Kyle R Eberlin, Raymond Malcolm Smith
The principles of open fracture management are to manage the overall injury and specifically prevent primary contamination becoming frank infection. The surgical management of these complex injuries includes debridement & lavage of the open wound with combined bony and soft tissue reconstruction. Good results depend on early high quality definitive surgery usually with early stable internal fixation and associated soft tissue repair. While all elements of the surgical principles are very important and depend on each other for overall success the most critical element appears to be achieving very early healthy soft tissue cover...
February 21, 2018: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/29537958/strategies-for-management-of-periprosthetic-joint-infection
#3
Aldo Riesgo, Frank Liporace
Periprosthetic joint infection (PJI) is one of the most catastrophic and difficult to manage complications following total hip and total knee arthroplasty. As the number of total joint arthroplasties continues to increase, the burden of PJI will continue to further strain resources. As such, orthopedic surgeons consider four principles crucial in appropriately managing difficult or complex cases of PJI: identification, debridement, antibiotics, and patience. Indications and techniques for nonoperative treatment, debridement with implant retention, and one- and two-stage exchange arthroplasty are reviewed...
March 2018: Bulletin of the Hospital for Joint Diseases
https://www.readbyqxmd.com/read/29424644/effectiveness-of-a-monofilament-wound-debridement-pad-at-removing-biofilm-and-slough-ex-vivo-and-clinical-performance
#4
Gregory S Schultz, Kevin Woo, Dot Weir, Qingping Yang
OBJECTIVE: Removal of slough and other devitalised tissue is an important step in biofilm-based wound care (BBWC) and wound bed preparation. Debridement is key to management of both slough and biofilm, and a number of methods are available to achieve this, including surgical/sharp and mechanical debridement. Developments have led to products indicated for debridement of wounds, including a sterile pad consisting of monofilament fibres. Our aim is to examine the effectiveness of a monofilament wound debridement pad (WDP), Debrisoft...
February 2, 2018: Journal of Wound Care
https://www.readbyqxmd.com/read/29349034/arthroscopic-microfracture-of-hip-chondral-lesions
#5
H Atil Atilla, T David Luo, Allston J Stubbs
Microfracture of hip chondral lesions has been performed for more than a decade with modified treatment principles and techniques from knee arthroscopy. This note and accompanying video review the pertinent techniques, pearls, and pitfalls of the microfracture procedure in the treatment of hip chondral lesions. After debridement of damaged chondral tissue, the size of the lesion is approximated to determine the number of microfracture holes to create. The working portal may be adjusted based on the site of the lesion...
December 2017: Arthroscopy Techniques
https://www.readbyqxmd.com/read/29166254/proactive-and-early-aggressive-wound-management-a-shift-in-strategy-developed-by-a-consensus-panel-examining-the-current-science-prevention-and-management-of-acute-and-chronic-wounds
#6
Gregory A Bohn, Gregory S Schultz, Brock A Liden, Michael N Desvigne, Eric J Lullove, Igor Zilberman, Mary B Regan, Marta Ostler, Karen Edwards, Georgia M Arvanitis, Jodi F Hartman
Normal wound healing is accomplished through a series of well-coordinated, progressive events with overlapping phases. Chronic wounds are described as not progressing to healing or not being responsive to management in a timely manner. A consensus panel of multidisciplinary wound care professionals was assembled to (1) educate wound care practitioners by identifying key principles of the basic science of chronic wound pathophysiology, highlighting the impact of metalloproteinases and biofilms, as well as the role of the extracellular matrix; and (2) equip practitioners with a systematic strategy for the prevention and healing of acute injuries and chronic wounds based upon scientific evidence and the panel members' expertise...
November 2017: Wounds: a Compendium of Clinical Research and Practice
https://www.readbyqxmd.com/read/28941569/wound-ballistics-and-blast-injuries
#7
N J Prat, J-L Daban, E J Voiglio, F Rongieras
Wounds due to gunshot and explosions, while usually observed during battlefield combat, are no longer an exceptional occurrence in civilian practice in France. The principles of wound ballistics are based on the interaction between the projectile and the human body as well as the transfer of energy from the projectile to tissues. The treatment of ballistic wounds relies on several principles: extremity wound debridement and absence of initial closure, complementary medical treatment, routine immobilization, revision surgery and secondary closure...
December 2017: Journal of Visceral Surgery
https://www.readbyqxmd.com/read/28802423/effectiveness-of-exchange-k-nail-and-augmented-plating-in-aseptic-femoral-diaphyseal-non-union
#8
K H Sancheti, Chetan Pradhan, Atul Patil, Chetan Puram, Parkalp Bharti, Parag Sancheti, Ashok Shyam
BACKGROUND: Femoral diaphyseal non-unions present difficult scenario to manage. There are multiple options but most of them still report varying incidences of failure. We combined the principles of augmented plating and exchange nailing and aim to study the effectiveness of this technique. METHOD: A retrospective study at a tertiary trauma centre was conducted. Seventy patients (60 men, 10 women), average age 40.7±15.27 years (range 18-81 years) with diaphyseal femoral fracture non-unions treated between July 2010 and January 2015 were reviewed...
August 2017: Injury
https://www.readbyqxmd.com/read/28706766/a-case-based-review-of-the-management-of-penetrating-brain-trauma
#9
Jason Milton, Alex Rugino, Kailash Narayan, Chris Karas, Victor Awuor
Principles of penetrating head trauma management were established by Harvey Cushing in relation to the management of penetrating brain injuries of World War One. Cushing radically debrided the scalp and skull and aggressively irrigated wound tracks to remove foreign bodies. He would then obtain water-tight closure. Cushing significantly decreased infection rates which reportedly limited the major cause of mortality due to penetrating head injuries. Many advances have been made by contributions from World War Two, Korean War, Vietnam War, and Iran/Iraq conflicts...
June 12, 2017: Curēus
https://www.readbyqxmd.com/read/28678628/indications-for-hip-arthroscopy
#10
REVIEW
James R Ross, Christopher M Larson, Asheesh Bedi
CONTEXT: Hip arthroscopy is gaining popularity within the field of orthopaedic surgery. The development and innovation of hip-specific arthroscopic instrumentation and improved techniques has resulted in improved access to the hip joint and ability to treat various hip pathologies. EVIDENCE ACQUISITION: Electronic databases, including PubMed and MEDLINE, were queried for articles relating to hip arthroscopy indications (1930-2017). STUDY DESIGN: Clinical review...
September 2017: Sports Health
https://www.readbyqxmd.com/read/28639529/circular-external-fixation-and-cemented-pmma-spacers-for-the-treatment-of-complex-tibial-fractures-and-infected-nonunions-with-segmental-bone-loss
#11
Andries H van Niekerk, Franz F Birkholtz, Phillip de Lange, Kevin Tetsworth, Erik Hohmann
PURPOSE: The purpose of this study was to compare the outcome of combined circular external fixation and cemented polymethylmethacrylate (PMMA) spacer application between a cohort of patients with grade 3 open fractures and infected tibial nonunions and concomitant segmental bone loss. METHODS: The study was designed as a retrospective cohort study. All patients who were treated for complex tibial fractures or infected nonunions with segmental bone loss between 2009 and 2013 were included if they were aged between 16 years and 60 years, sustained acute traumatic grade 3 open tibial fractures, presented with infected nonunion, and were followed up for a minimum of 12 months...
May 2017: Journal of Orthopaedic Surgery
https://www.readbyqxmd.com/read/28501719/colliding-jets-provide-depth-control-for-water-jetting-in-bone-tissue
#12
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...
August 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
#13
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
#14
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)...
September 2017: International Orthopaedics
https://www.readbyqxmd.com/read/28381378/severe-acute-pancreatitis-pathogenesis-diagnosis-and-surgical-management
#15
REVIEW
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
#16
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
#17
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
#18
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
#19
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
#20
REVIEW
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
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