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principles of debridement

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
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
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
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
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
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
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
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
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...
September 21, 2016: Burns: Journal of the International Society for Burn Injuries
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
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
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
Cyril Mauffrey, Nathan Butler, Mark E Hake
Successful management of intramedullary long bone osteomyelitis remains a challenge for both surgeons and patients. Patients are often immune compromised and have endured multiple surgeries. Treatment principles include antibiotic administration (systemically ± locally), surgical debridement of the infection site, and stabilization. Since their description in 2002, antibiotic-coated nails have become part of the armamentarium for the treatment of osteomyelitis allowing both local elution of antibiotics and stabilization of a debrided long bone...
August 2016: Journal of Orthopaedic Trauma
Jessica B Hancock-Allen, Sarah J Janelle, Kate Lujan, Wendy M Bamberg
BACKGROUND: In September 2014, wound clinic A reported a cluster of group A Streptococcus (GAS) infections to public health authorities. Although clinic providers were individually licensed, the clinic, affiliated with hospital A, was not licensed or subject to regulation. We investigated to identify cases, determine risk factors, and implement control measures. METHODS: A case was defined as GAS isolation from a wound or blood specimen during March 28-November 19, 2014, from a patient treated at wound clinic A or by a wound clinic A provider within the previous 7 days...
June 13, 2016: American Journal of Infection Control
Siddharth Rai, Anil Kumar Gupta, Dileep Kumar, Vijai Prakash Sharma, Ashok Kumar Agarwal
BACKGROUND: Chronic planter ulcer, also known as trophic ulcer, shows no tendency towards healing. It is usually seen in sensory deficient foot. The clinical result of a sensory, motor or autonomic loss of a nerve function is frequently the same--ulceration, although the exact cause may vary. The treatment principle involves dressing and avoiding pressure on the ulcerated site called 'offloading' and patient education for prevention. AIM OF THE STUDY: To determine the outcome of non-healing planter ulcers in an anaesthetic foot treated with offloading, total contact casting (TCC), in terms of rate and duration of healing and percentage of ulcers healed based on improvement of Wagner's grading with respect to the clinical profile of the patient...
March 2016: Leprosy Review
M Krtička, D Ira, V Nekuda, J Švancara, M Mašek
UNLABELLED: PURPOSE OF THE STUDY Grade III open fractures are associated with infectious complications in 25-66% of injuries. Negative pressure wound therapy (NPWT) applied to an injured soft tissue coverage provides an impermeable barrier between the injured structures and the external environment, in addition to early secretion draining and a positive effect on the site of application. All this also prevents secondary bacterial contamination. The objective of the study was to compare the results of treatment methods in view of infectious complications in patients with soft tissue injury in grade-III open fractures managed either by NPWT and primary closure or by covering with combined dressing fabric (COM) in combination with continual wound lavage...
2016: Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca
Robert J Snyder, Caroline Fife, Zena Moore
OBJECTIVES: To discuss how patient considerations and the initial wound environment can affect wound treatment and summarize the way in which the initial US Wound Registry measures capture aspects of the DIME (Debridement/devitalized tissue, Infection or inflammation, Moisture balance, and wound Edge preparation/wound depth) principles. DISCUSSION: The treatment of chronic wounds often involves extended hospital stays and long-term outpatient follow-up visits with costly advanced therapeutic interventions...
May 2016: Advances in Skin & Wound Care
M T Zacher, A M Högele, M Hanschen, F von Matthey, A-K Beer, F Gebhardt, P Biberthaler, K-G Kanz
Wound management is one of the major tasks in emergency departments. The surrounding intact skin but not the wound itself should be disinfected before starting definitive wound treatment. Hair should first be removed by clipping to 1-2 mm above the skin with scissors or clippers as shaving the area with a razor damages the hair follicles and increases the risk of wound infections. Administration of local anesthetics should be performed directly through the exposed edges of the wound. After wound examination, irrigation is performed with Ringer's solution, normal saline or distilled water...
April 2016: Der Anaesthesist
Chandan Jadhav, Jeremy Rawlins
BACKGROUND: Temperoparietal scalp defects are fairly common resulting from varied array of etiology. Various reconstructive options exisit, but the aim was to achieve a reliable and simple solution keeping in mind the principle of replacing "like with like." METHODS: The authors present a 83-year-old lady who had a fall at her home and was lying unconscious for quite some time on her right side of her temple, leading to full thickness necrosis of overlying scalp...
May 2016: Journal of Craniofacial Surgery
Paul J Kim, Christopher E Attinger, Olayinka Olawoye, Brett D Crist, Allen Gabriel, Robert D Galiano, Subhas Gupta, John C Lantis Ii, Lawrence Lavery, Benjamin A Lipsky, Luc Teot
Negative pressure wound therapy with instillation (NPWTi) and dwell time is an adjunctive treatment modality for selected complex wounds. Because of the greater amount of research now available, a multidisciplinary expert panel comprising the fields of podiatry, plastic and general surgery, burn treatment, infectious diseases, and orthopedics was convened on July 11, 2015, to produce a summary of the data and recommendations on the use of NPWTi. The panel members each reviewed available published literature on NPWTi in the PubMed, Cochrane, and Google Scholar databases from 1 January 2012 up until 20 July 2015 using the string search term negative pressure wound therapy instillation provided by the panel moderator; there were no restrictions on the language or type of publication...
December 2015: Wounds: a Compendium of Clinical Research and Practice
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