Debridement Of Lesions Research Articles

Prise en charge des lésions des parties molles du purpura fulminans chez l’enfant

Purpura fulminans is a pediatric life-threatening emergency with a significant mortality, combining: septic shock, extensive purpuric lesions and disseminated intravascular coagulation. The most frequent bacterial pathogen is the meningococcus. The medical management includes antibiotics, corticoids, vascular filling and catecholamines. Purpura fulminans is characterized by the extent of hemorrhagic and mainly thrombotic lesions, attributed to the alteration in the vascular endothelium functions. Damage of soft tissues combines large necrotic areas and more or less extensive distal ischemic lesions. Necrotic lesions can be deep, reaching skin, subcutaneous tissue, fascia, muscle and sometimes even the bone. The importance of the aesthetic and functional sequelae as well as future quality of life, depend on the quality of surgical management for these wide and deep lesions. Fasciotomy is sometimes urgently needed in the case of a clinical compartment syndrome, confirmed by a high-pressure measurement in the muscle compartments. Debridement of necrotic lesions and amputations are only performed after a clear delineation of necrotic areas, between 10days and 3weeks of evolution. If an amputation is necessary, it must focus on the residual bone length, considering the child's growth potential. The coverage of tissue loss uses all the plastic surgery techniques, more or less complex, in order to reduce scars to minimum for these children. Rehabilitation follow-up includes physical and psychological care, which are essential until adulthood.

Anterior debridement may not be necessary in the treatment of tuberculous spondylitis of the thoracic and lumbar spine in adults: a retrospective study.

Many aspects of the surgical treatment of patients with tuberculosis (TB) of the spine, including the use of instrumentation and the types of graft, remain controversial. Our aim was to report the outcome of a single-stage posterior procedure, with or without posterior decompression, in this group of patients. Between 2001 and 2010, 51 patients with a mean age of 62.5 years (39 to 86) underwent long posterior instrumentation and short posterior or posterolateral fusion for TB of the thoracic and lumbar spines, followed by anti-TB chemotherapy for 12 months. No anterior debridement of the necrotic tissue was undertaken. Posterior decompression with laminectomy was carried out for the 30 patients with a neurological deficit. The mean kyphotic angle improved from 26.1° (- 1.8° to 62°) to 15.2° (-25° to 51°) immediately after the operation. At a mean follow-up of 68.8 months (30 to 144) the mean kyphotic angle was 16.9° (-22° to 54°), with a mean loss of correction of 1.6° (0° to 10°). There was a mean improvement in neurological status of 1.2 Frankel grades in those with a neurological deficit. Bony union was achieved in all patients, without recurrent infection. Long posterior instrumentation with short posterior or posterolateral fusion is effective in the treatment of TB spine. It controls infection, corrects the kyphosis, and maintains correction and neurological improvement over time. With effective anti-TB chemotherapy, a posterior only procedure without debridement of anterior lesion is effective in the treatment of TB spondylitis, and an anterior procedure can be reserved for those patients who have not improved after posterior surgery. Cite this article: Bone Joint J 2016;98-B:834-9.

Bone-peg grafting for osteochondritis dissecans of the humeral capitellum.

To review the outcome of bone-peg grafting for osteochondritis dissecans (OCD) grade II lesions of the humeral capitellum. Records of 10 male adolescent baseball players aged 10 to 15 (mean, 12.3) years who underwent bone-peg grafting for OCD grade II lesions of the humeral capitellum of the dominant arm were reviewed. The mean time from symptom onset to presentation was 11 (range, 1-36) months. The mean duration of conservative treatment was 5 (range, 1-25) months. The mean time from symptom onset to surgery was 17 (range, 3-39) months; it was >6 months in 6 patients. The mean size of the lesions was 13x14 mm. Patients were assessed for elbow pain, range of elbow and forearm motion, Timmerman- Andrews elbow score, return to sports activity level, and radiographic evidence of healing, osteoarthritic changes, and radial head hypertrophy. The mean follow-up period was 25 (range, 10-52) months. Postoperatively, elbow pain was absent in 6, mild in 2, and moderate in 2 patients. The mean range of elbow motion changed from 136º to 139° (p=0.80). The mean Timmerman-Andrews elbow score improved from 163 to 189 (p=0.014); it was excellent in 7, good in 2, and fair in one patient. The mean extent of lesion healing was 71% (range, 33-100%). Five patients achieved complete healing after a mean of 5.2 (range, 5-6) months and returned to sports at a competitive level. The other 5 achieved partial healing of 33 to 56% (mean, 41%) that occurred laterally but not medially. Two of them returned to sports at a competitive level: one changed the throwing side and another had radial head hypertrophy. The remaining 3 underwent arthroscopic debridement of the unhealed lesion at 5, 10, and 15 months. One patient developed secondary osteoarthritis and further underwent costal osteochondral autografting 10 months later. None of the 5 patients with partial healing versus 4 of the 5 patients with complete healing underwent surgery within 6 months of symptom onset. All 3 patients with a dot at the interface versus 2 of the 6 patients with a line at the interface between the fragment and the lesion on MRI had complete healing. Bone-peg grafting is a viable option for OCD grade II lesions of the humeral capitellum when performed within 6 months of symptom onset and when the interface between the fragment and the lesion appears as a dot (rather than a line) on MRI.

Mucoid degeneration of the anterior cruciate ligament: Partial arthroscopic debridement and outcomes

BackgroundMucoid degeneration of the anterior cruciate ligament (ACL) is a common pathology but is often unknown and underdiagnosed. Mucinous material within the substance of ACL produces pain and limited motion in the knee. The purpose of this study was to diagnose mucoid degeneration of ACL and to assess the effectiveness of arthroscopic treatment in these patients. Materials and methodsBetween 2011 and 2014, 13 patients were diagnosed to be suffering from mucoid degeneration of ACL on the basis of magnetic resonance imaging (MRI), histopathology, and arthroscopy findings. All the patients had clinical symptoms of central knee pain behind patella and were unable to extend knees fully because of pain without instability. The aim of surgery was to remove as much of the degenerative mass as possible without having to sacrifice the entire ACL. Thus, the remaining ACL consisted of some intact anteromedial or posterolateral portion of the ACL interspersed with degenerate ACL tissue. Copious debridement of mucoid hypertrophied lesions of the ACL was performed. ResultsMean follow-up was of 8.4 months (range 6–12 months) and all except one patient had a full range of painless motion. All patients have resumed their normal daily activities. None complained of any instability. Postoperatively, 12 knees showed complete pain relief and 1 showed pain improvement by at least 4 Visual Analogue Scale (VAS) grades and preoperative average International Knee Documentation Committee (IKDC) score 8 was 36.39 which improved postoperatively to the average 73.18. ConclusionsMucoid degeneration of the ACL should be suspected in patients presenting pain on terminal extension or flexion without preceding trauma. Prior knowledge of condition with high index of suspicion and careful interpretation of MRI can establish the diagnosis preoperatively. Arthroscopic debridement with or without notchplasty gives excellent functional results.

Effect on Patient-Reported Outcomes of Debridement or Microfracture of Concomitant Full-Thickness Cartilage Lesions in Anterior Cruciate Ligament–Reconstructed Knees

Background: The treatment of concomitant cartilage lesions in anterior cruciate ligament (ACL)–injured knees is debatable. Purpose: To evaluate the effect of debridement or microfracture (MF) compared with no treatment of concomitant full-thickness (International Cartilage Repair Society [ICRS] grades 3-4) cartilage lesions on patient-reported outcomes after ACL reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: Six hundred forty-four patients who underwent primary unilateral ACL reconstruction and had a concomitant full-thickness cartilage lesion treated simultaneously by debridement (n = 129) or MF (n = 164), or underwent no treatment (n = 351) of the cartilage lesion, registered in the Norwegian and Swedish National Knee Ligament Registries from 2005 to 2008 were included. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to measure patient-reported outcomes. At a mean follow-up of 2.1 ± 0.2 years after surgery, 357 (55%) patients completed the KOOS. Linear regression analyses were used to evaluate the effect of debridement or MF on the KOOS. Results: No significant effects of debridement were detected in the unadjusted or adjusted regression analyses on any of the KOOS subscales at 2-year follow-up. The MF treatment of the cartilage lesions had significant negative effects at 2-year follow-up on the KOOS Sport and Recreation (Sport/Rec) (regression coefficient [β] = −8.9; 95% confidence interval [CI], −15.1 to −1.5) and Knee-Related Quality of Life (QoL) (β = −8.1; 95% CI, −14.1 to −2.1) subscales in the unadjusted analyses. When adjusting for confounders, MF had significant negative effects on the same KOOS subscales of Sport/Rec (β = −8.6; 95% CI, −16.4 to −0.7) and QoL (β = −7.2; 95% CI, −13.6 to −0.8). For the remaining KOOS subscales of Pain, Symptoms, and Activities of Daily Living, there were no significant unadjusted or adjusted effects of MF. Conclusion: MF of concomitant full-thickness cartilage lesions showed adverse effects on patient-reported outcomes at 2-year follow-up after ACL reconstruction. Debridement of concomitant full-thickness cartilage lesions showed neither positive nor negative effects on patient-reported outcomes at 2-year follow-up after ACL reconstruction.

Bacille Calmette-Guérin Osteomyelitis.

Tuberculosis is an essential problem for healthcare systems especially in developing countries. All newborns are given Bacillus Calmette-Guérin (BCG) vaccine in Iran which is prepared from live bovine tuberculosis bacillus, and is given to protect against tuberculosis. Osteomyelitis secondary to BCG vaccination is rare and usually involves epiphysis of long tubular bones. 4 patients, 3 males and a female entered this study and were between 11 to 24 months old. The involved bones were first metatarsi, talus, humerus and tibia bone. The main radiologic finding was lytic lesion with cortical destruction and periosteal reaction. 3 patients underwent core needle biopsy and the one with the proximal tibia involvement, underwent open surgery. Pathology report suggested granulomatous osteomyelitis and typical caseous necrosis compatible with tuberculosis. Surgical treatment for these patients was curettage and debridement of the bone lesion and involved tissues around. The patients got standard anti TB pharmacotherapy, were completely cured and no short term complication was seen in a one year follow up. BCG osteomyelitis and cold abscess, should be kept in mind when assessing a child presenting chronic symptoms like pain, limping or local swelling of extremities. The long interval time between BCG vaccination and outbreak of the culture-negative abscess is a major point which emphasizes on pathologic evaluation. Image guided tissue biopsy and PCR studies confirm diagnosis. Early use of a surgical curettage and debridement along with chemotherapy soon afterwards, enabled these children to enjoy a satisfactory clinical outcome.

Abrasion arthroplasty increases mesenchymal stem cell content of postoperative joint effusions.

BackgroundAbrasion arthroplasty (AAP) is a procedure by which intrinsic cartilage healing is believed to be stimulated. Although clinically accepted for degenerative and traumatic cartilage lesions scientific evidence at a molecular level that proves the effect of AAP is scarce.MethodMononuclear cells were extracted from postoperative joint effusions 21.5 h post AAP and simple debridement of cartilage lesions. Luminex, ELISA and FACS experiments were performed. Immunohistochemical stainings of cell cultures for cartilage markers were used to confirm the findings.ResultsPostoperative joint effusions after AAP showed increased contents of Mononuclear cells compared to Arthroscopic Chondroplasty (ACP). BMP-4 and IGF were increased in AAP as complared to ACP. Mononuclear cells isolated after AAP express the MSC markers CD 73, CD 105, CD 90, CD 44 and are CD34 negative. Chondrogenic differentiation was demonstrated by positive staining for Sox9, collagen II, proteoglycan, chondroitin-4-sulfate.ConclusionOur results support the clinical application of AAP as a procedure that enhances cartilage repair as an alternative to far more complex procedures that have gained popularity. Furthermore the data presented supports clinical investigations that recommend not to use suction drainage as by this procedure a considerable amount of the regeneratory potential of postoperative joint effusions might be extracted.

Design of a randomized controlled trial to compare debridement to observation of chondral lesions encountered during partial meniscectomy: The ChAMP (Chondral Lesions And Meniscus Procedures) Trial

BackgroundFew studies have examined whether chondral lesions encountered in patients undergoing meniscectomy should be surgically treated. The primary aim of the ChAMP (Chondral Lesions And Meniscus Procedures) Trial is to determine whether there is a difference in knee pain between patients undergoing debridement versus observation of chondral lesions encountered during arthroscopic meniscectomy. This paper describes the rationale and study design for the ChAMP Trial. Methods/DesignThe ChAMP Trial is a randomized controlled trial of patients aged 30 and older undergoing partial meniscectomy and randomly allocated to debridement (CL-Deb, N=98) or observation (CL-Obs, N=92) of chondral lesions identified during surgery and deemed to be significant (Outerbridge Grade II-IV). Patients and data collectors were unaware of treatment allocation until completion of the study. Patients with surgically insignificant (Outerbridge Grade I) chondral lesions or no chondral lesions were included as a third non-randomized comparison group (NoCL, N=76). The primary outcome is the difference in knee pain assessed by WOMAC (Western Ontario and McMaster Universities Arthritis Index) between the CL-Deb and CL-Obs groups at 1-year after surgery. Secondary outcomes include 1-year differences in additional measures of knee pain, function, symptoms, activity, and quality of life assessed by the WOMAC, KOOS (Knee Injury and Osteoarthritis Outcome Score), visual analog pain scale, and physical exam; as well as general health assessed with the SF-36 (Short-form Health Survey). Increased intraoperative costs associated with the addition of chondral debridement will also be assessed. DiscussionThis study will add to the scant literature regarding management of chondral lesions in patients undergoing meniscectomy and might provide treatment guidance for clinicians and their patients.

Effect on Patient-Reported Outcome of Debridement or Microfracture of Concomitant Full-Thickness Cartilage Lesions in Anterior Cruciate Ligament-Reconstructed Knees

Objectives:To evaluate the effect of debridement or microfracture compared with no treatment of concomitant full-thickness (International Cartilage Repair Society [ICRS] grades 3-4) cartilage lesions on patient-reported outcome after ACL reconstruction in a large population-based cohort study.Methods:644 patients with a primary unilateral ACL reconstruction and a concomitant full-thickness cartilage lesion treated simultaneously by debridement (n=78) or microfracture (n=88), or receiving no treatment (n=191) of the cartilage lesion, registered in the Norwegian and the Swedish National Knee Ligament Registry during 2005-2008 were included. Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to measure patient-reported outcome. At a mean follow-up of 2.1 years (SD, 0.2) after surgery, 357 (55%) patients completed the KOOS. Linear regression analyses were used to evaluate the effect of debridement or microfracture on KOOS. The multiple regression analyses were adjusted for gender, age, previous knee surgery, time from injury to surgery, concomitant ligament injury, concomitant meniscal lesion(s), type of ACL graft, area of cartilage lesion, ICRS grade of cartilage lesion, location of cartilage lesion and preoperative KOOS scores.Results:No significant effects of debridement were detected in the unadjusted or adjusted regression analyses on any of the KOOS subscales at 2-year follow-up. Microfracture treatment of the cartilage lesions had significant negative effects at 2 year follow-up on the KOOS subscales Sport/Recreation (regression coefficient [β] = -8.9; 95% CI, -15.1 to -1.5) and Knee-Related Quality of Life (QoL) (β = -8.1; 95% CI, -14.1 to -2.1) in the unadjusted analyses. When adjusting for confounders, microfracture had significant negative effects on the same KOOS subscales, Sport/Recreation (β = -9.1; 95% CI, -16.9 to -1.2), and QoL (β = -7.3; 95% CI, -13.7 to -0.9). For the remaining KOOS subscales Pain, Symptoms and Activity of Daily Living (ADL) there were no significant unadjusted or adjusted effects of microfracture.Conclusion:Microfracture of concomitant full-thickness cartilage lesions showed adverse effects on patient-reported outcome at 2-year follow-up after ACL reconstruction. Debridement of concomitant full-thickness cartilage lesions showed neither positive nor negative effects on patient-reported outcome at 2-year follow-up after ACL reconstruction.

Tricuspid and pulmonary valve endocarditis associated with double-chambered right ventricle

We report a rare case of tricuspid valve and pulmonary valve endocarditis associated with a double-chambered right ventricle in an adult female with pulmonary artery aneurysm and septic pulmonary embolism by Streptococcus mitis. She was treated with aggressive antibiotic therapy followed by debridement of the infective lesion of tricuspid valve, pulmonary valve replacement using xenograft and resection of obstructing muscular bundles in right ventricle.

Treatment of Secondary Osteonecrosis of the Knee With Local Debridement and Osteoprogenitor Cell Grafting

Secondary osteonecrosis of the knee (SOK) affects young individuals with chronic diseases and corticosteroid use. We report a series of young patients in whom the osteonecrotic lesion was openly debrided, and concentrated bone marrow osteoprogenitor cells (OPCs) harvested from the iliac crest were placed in the defect. Twelve patients (fourteen knees) have undergone debridement and grafting of distal femoral osteonecrotic lesions. Age at surgery averaged 23years. Follow-up averaged 5years. None of the patients have undergone further surgery, or were taking medications for ipsilateral knee pain. Knee Society Score and Knee Function Score averaged 87 and 85 respectively. The technique of open debridement and osteoprogenitor cell grafting for SOK is relatively simple, efficacious, has low morbidity, and does not preclude future interventions.

Inflammatory myofibroblastic tumor of the hand: A case report.

The present study reports the case of a 58-year-old male patient who repeatedly presented with hand ulcers that were diagnosed as cellulitis. Upon histological analysis, however, an inflammatory myofibroblastic tumor (IMT) was diagnosed. IMTs rarely occur in the hands. The involved tissue was removed with the tumor, with the exception of the tendons and cutaneous nerve. The involved tendon sheath and epineurium were carefully resected. After 2 years of follow-up, the patient showed no signs of tumor recurrence and the hand function was good. IMTs in the hands are relatively rare, and are often easily misdiagnosed as infection. An early and correct diagnosis is the key to successful treatment. A biopsy is necessary following debridement of the infected lesion, particularly for recurrent infected lesions. The surgical approach should be conservative, in order to maintain maximum hand function.

Functionality After Arthroscopic Debridement of Central Triangular Fibrocartilage Tears With Central Perforations

To investigate functional and subjective outcome parameters after arthroscopic debridement of central articular disc lesions (Palmer type 2C) and to correlate these findings with ulna length. Fifty patients (15 men; 35 women; mean age, 47 y) with Palmer type 2C lesions underwent arthroscopic debridement. Nine of these patients (3 men; 6 women; mean static ulnar variance, 2.4 mm; SD, 0.5 mm) later underwent ulnar shortening osteotomy because of persistent pain and had a mean follow-up of 36 months. Mean follow-up was 38 months for patients with debridement only (mean static ulnar variance, 0.5 mm; SD, 1.2 mm). Examination parameters included range of motion, grip and pinch strengths, pain (visual analog scale), and functional outcome scores (Modified Mayo Wrist score [MMWS] and Disabilities of the Arm, Shoulder, and Hand [DASH] questionnaire). Patients who had debridement only reached a DASH questionnaire score of 18 and an MMWS of 89 with significant pain reduction from 7.6 to 2.0 on the visual analog scale. Patients with additional ulnar shortening reached a DASH questionnaire score of 18 and an MMWS of 88, with significant pain reduction from 7.4 to 2.5. Neither surgical treatment compromised grip and pinch strength in comparison with the contralateral side. We identified 1.8 mm or more of positive ulnar variance as an indication for early ulnar shortening in the case of persistent ulnar-sided wrist pain after arthroscopic debridement. Arthroscopic debridement was a sufficient and reliable treatment option for the majority of patients with Palmer type 2C lesions. Because reliable predictors of the necessity for ulnar shortening are lacking, we recommend arthroscopic debridement as a first-line treatment for all triangular fibrocartilage 2C lesions, and, in the presence of persistent ulnar-sided wrist pain, ulnar shortening osteotomy after an interval of 6 months. Ulnar shortening proved to be sufficient and safe for these patients. Patients with persistent ulnar-sided wrist pain after debridement who had preoperative static positive ulnar variance of 1.8 mm or more may be treated by ulnar shortening earlier in order to spare them prolonged symptoms. Therapeutic IV.

Comparative study between photodynamic and antibiotic therapies for treatment of footpad dermatitis (bumblefoot) in Magellanic penguins (Spheniscus magellanicus)

Bumblefoot, referring to bed-sore-like foot lesions, is one of the most important clinical complications in captive birds and has a multifactorial etiology. Photodynamic therapy has been proposed as an alternative treatment for localized infections in response to the escalating problem of antibiotic resistance. The aim of this study was to compare outcomes in a group of captive Spheniscus magellanicus with bumblefoot lesions treated with photodynamic therapy (PDT) or antibiotics (ATB). Ten captive Magellanic penguins with preexisting stage III bumblefoot lesions were selected and randomly divided into one PDT and one ATB group, each including 11 pelvic-limb lesions. All animals underwent surgical debridement of lesions. In the ATB group, antibiotic ointment was applied topically three times a week, and systemic antibiotic and anti-inflammatory drugs were administered daily. In the PDT group, photodynamic therapy was applied three times a week without the use of topical or systemic medication. Lesion areas were photographed, and swabs were collected for culture and sensitivity, on the first day and every 14 days for a total of 84 days. The four species of bacteria showing the most resistance to the antibiotics screened on the antibiogram were used to determine resistance to PDT with an in vitro test. There were significant differences in healing rate and average healing time between the PDT and ATB groups (63.62% vs. 9.09% and 42 vs. 70 days, respectively). The findings of this study attest to the effectiveness of photodynamic therapy for the treatment of stage III bumblefoot in Spheniscus magellanicus.

Effects of gatifloxaine content in gatifloxacine-loaded PLGA and β-tricalcium phosphate composites on efficacy in treating osteomyelitis.

Composites of gatifloxacin (GFLX)-loaded poly (lactic-co-glycolic) acid (PLGA) and β-tricalcium phosphate (βTCP) containing 0, 1, and 10 wt % GFLX (0, 1, and 10 wt % GFLX composites), and GFLX-loaded PLGA containing 1, 5, and 10 wt % GFLX (1, 5, and 10wt % GFLX-PLGA) as controls were fabricated and characterized in vitro and in vivo. On in vitro evaluation, the 10 wt % GFLX composite released GFLX over at least 28 days in Hanks' balanced solution and exhibited clinically sufficient bactericidal activities against Streptococcus milleri and Bacteroides fragilis from 1 h to 10 days. The 0, 1, and 10 wt % GFLX composites and 10 wt % GFLX-PLGA were implanted in bone defects created by debridement of osteomyelitis lesions induced by S. milleri and B. fragilis in the mandible of rabbits (n = 5). Four weeks after implantation of the 10 wt % GFLX composite, inflammation in the debrided area disappeared in all the rabbits, while inflammation remained in all the rabbits after implantation of the 0 wt % GFLX composite and 10 wt % GFLX-PLGA, and in three rabbits after implantation of the 1 wt % GFLX composite. Bone formation appears to be less intense for the 10 wt % GFLX composite than for the 1 wt % GFLX composite probably owing to the rapid degradation of the 10 wt % GFLX composite. These findings show that the GFLX composite is effective for the local treatment of osteomyelitis.

Bacteremia in the pedal circulation following regional intravenous perfusion of a 2% lidocaine solution in cattle with deep digital sepsis.

To evaluate whether pedal bacteremia develops following regional IV perfusion (RIVP) of a 2% lidocaine hydrochloride solution in cattle with deep digital sepsis (DDS) and to determine which bacterial pathogens are most commonly isolated from the pedal circulation. Prospective observational cohort study. 9 adult cattle with DDS in 10 limbs and 10 healthy adult cattle with no evidence of lameness or digital infection. Blood samples were obtained aseptically from the dorsal common digital vein immediately following tourniquet application and 30 to 60 minutes after aseptic RIVP with a 2% lidocaine solution. Aerobic and anaerobic bacterial cultures were performed on all samples collected. For cattle with DDS, clinical examination with or without debridement of digital lesions was performed after RIVP. Bacteria were isolated from pedal blood prior to RIVP in 1 cow with DDS and after RIVP and examination with or without debridement in that cow and 4 additional cattle with DDS. Bacteria were not isolated from any blood sample obtained from the healthy cattle. Of the 8 bacterial isolates identified, 5 were gram-positive facultative anaerobes. Cattle with DDS were significantly more likely to develop bacteremia in the pedal circulation than were healthy cattle following RIVP. Results indicated that bacteremia may be present in the pedal circulation before and following RIVP and examination with or without debridement in cattle with DDS. Thus, systemic or local antimicrobial treatment might be warranted prior to or concurrently with RIVP in cattle with DDS.

Debridement combined with bandage contact lens for mild fungal corneal ulcer

Objective To observe the clinical effect of corneal lesion debridement combined with bandage contact lens for mild fungal corneal ulcer.Methods Sixteen eyes of 16 patients with mild fungal corneal ulcer underwent debridement combined with bandage contact lens and antifungal drugs.The observational time was over 6 months.Results The corrected visual acuity before treatment was at finger counting/10 cm to 0.2.16 cases were all cured and the corrected visual acuity was at 0.05 to 0.8.Conclusion Corneal lesion debridement combined with bandage contact lens is effective for mild fungal corneal ulcer. Key words: Ulcer, fungal,corneal,mild; Debridement,lesion,corneal; Lens,contact,bandage-type

Arthroscopic assessment of osteochondrosis of the medial humeral condyle treated with debridement and sliding humeral osteotomy.

To document the progression of disease after an unloading procedure when combined with arthroscopic debridement to treat osteochondrosis (OC) lesions affecting the medial humeral condyle in juvenile dogs without medial compartment disease. Retrospective case series. Dogs with medial humeral condyle OC (n = 6). Dogs with medial humeral condyle OC (9 elbows) were treated by arthroscopic debridement of the OC lesion and sliding humeral osteotomy (SHO). Outcomes were assessed by radiography (n = 9), 2nd-look arthroscopy (9) and clinical examination including lameness assessment (9) at 18-28 months after surgery. Seven elbows had marked progression of pathology affecting the medial compartment, 5 elbows developed subsequent fragmentation of the medial coronoid process of the ulna [FMCP], 2 elbows had fibrocartilaginous infill of the humeral defect without development of coronoid pathology. This limited case series suggests that medial compartment disease develops despite unloading of the medial compartment using a distal diaphyseal SHO in juvenile dogs with OC.

Tuberculosis of ultralong segmental thoracic and lumbar vertebrae treated by posterior fixation and cleaning of the infection center through a cross-window

Background contextSurgical treatment of thoracolumbar tuberculosis (TB) aims at spinal cord decompression, focus debridement, spine stability, and deformity correction. However, several problems exist in treating multiple segmental thoracolumbar TB, including reducing surgical trauma with effective incision exposure; ensuring the effective long-armed fixation, and maintaining the possibility for revisionary surgery in cases of treatment failure. PurposeTo investigate the clinical efficacy and surgical technique of the single posterior midline approach for screw-rod fixation and debridement through the sacrospinalis muscle outer cross-window to treat multiple segmental thoracolumbar spinal TB. Study designA retrospective cohort study. Patient sampleA group of 17 patients with spinal TB after surgical treatment, with a mean follow-up of 27.9 months (range, 18–48 months). Outcome measuresNeurologic recovery, Cobb angle, and graft union assessed by the Moon standard. MethodsThis study was approved by the local ethical committee and recruited patients from January, 2005 to January, 2011. We used a posterior midline incision for internal fixation of a pedicle screw system in the gap of the longissimus and spinal multifidus. Anterior lesion debridement and interbody fusions were performed through bilateral cross-windows in the outer edge of the sacrospinalis muscle. Using this technique, we treated 17 patients (10 men; aged 19 to 68 years; mean 39.8 years) with spinal TB involving more than four vertebrae. Nerve damage was classified by the Frankel classification. All patients were treated with regular anti-TB chemotherapy and were followed for 18 to 48 (mean: 27.9 months) months. ResultsThe mean (range) for operative time was 4.7 (3.6–6.3) hours, for blood loss during surgery was 1,100 (850–2,300) mL, and for time of interbody fusion was 6.3 (4 to 11) months. The Cobb angle correction rate is 67.1%. Nine of 11 patients' neurologic function returned to normal, which was statistically significant (p=.004). There was no TB recurrence or internal fixation failure. ConclusionsCombined with anti-TB chemotherapy, the discussed surgical technique can show improved lesion clearance, decompression of the anterior aspect of the spine, bone graft fusion, internal fixation of outside lesions, drainage and lead to positive treatment outcomes.

Infected Gluteal Hydatid Cyst

A 77-year-old woman, who had had a previous gluteal hydatid cyst that had been treated surgically years before, came to our Emergency Department due to suppuration through the scar, where daughter vesicles and purulent material were observed. Complementary tests were performed, and both CT and MRI demonstrated multivesicular hydatid cysts in the right gluteal muscle (Fig. 1), that affected the adjacent muscles and extended to the pelvis (Fig. 2), with alteration of the adjacent fat, possibly due to infection. With the diagnosis of infected extensive musculoskeletal hydatidosis, the patient was treated with debridement and resection of the accessible lesions, with a subsequent favorable evolution. c i r e s p . 2 0 1 4 ; 9 2 ( 7 ) : e 3 7