Methods Of Debridement Research Articles

A novel debridement device for the treatment of hard-to-heal wounds: a prospective trial

Debridement, the removal of nonviable tissue, forms the foundation of wound care practice. Clinicians have a variety of debridement methods at their disposal: sharp, biologic, enzymatic, autolytic and mechanical. The choice of debridement technique depends on the patient care setting, ulcer type and the clinician's experience, training, comfort level and licensure. This prospective study evaluated a novel debridement instrument, EZ-Debride (MDM Ventures, US). Cutting flutes on the head of the tool permit uniform removal of dead tissue while lessening the risk of deeper injury. It may also minimise pain during the debridement procedure. Subjects with hard-to-heal wounds, drawn from a single wound care centre, participated in this institutional review board-approved prospective clinical study. Pain was measured before, during and after debridement using a numerical scale. Assessment of bacterial burden using fluorescence imaging (MolecuLight, Canada) was performed before and after debridement. Enrolment of 10 male and 12 female subjects, with a total of 28 wounds, was carried out over a two-month period by two investigators at a single institution. The average age of subjects was 64 years (range: 22-95 years). The average wound duration was 29 weeks (range: 6-142 weeks). Wound types included diabetic foot, venous leg and pressure ulcers, post-surgical and traumatic wounds. The average pain score at the time of enrolment was 3.9. Subjects reported an average increase in pain with debridement of 0.6 points (range: 0-8). Fluorescence imaging demonstrated a reduction in bacterial load in 69% of cases, with complete resolution in 19% of wounds. Haemostasis was achieved with direct pressure in all cases and the only adverse event was a wound infection that occurred four days after debridement. The results suggest that this novel debridement tool can safely remove nonviable tissue with minimal discomfort and reduce bacterial burden similar to results achieved by sharp debridement.

COMPARATIVE STUDY OF ANTIBACTERIAL ACTIVITY OF PHOTOACTIVATED DISINFECTION WITH FOTOSAN AND STANDARD ENDODONTIC TREATMENT

Introduction: The purpose of endodontic treatment is to eliminate the bacterial infection in the root canal system and allow healing of apical periodontitis. Sometimes the anatomical complexity of the root canal system makes complete removal of bacteria almost impossible even if the conventional methods of chemo-mechanical debridement are performed strictly according to the protocol. So additional methods of root canal disinfection can be applied such as photoactivated disinfection (PAD). Purpose: The aim of our study was to compare the antibacterial activity of PAD with FotoSan, and conventional endodontic therapy in the treatment of infected root canals. Materials and methods: The study involved 36 teeth of patients who are diagnosed with pulp necrosis or with the periapical chronic periodontitis and require endodontic treatment and divided into two groups of 18 teeth each. The first microbiological sample was taken by placing a sterile paper point in the root canal, after endodontic access cavity preparation. All root canals are prepared by Protaper Universal rotary instruments (Maillefer Instruments SA, Ballaigues, Switzerland). In the first group, the disinfection of the root canals was made with photoactivated disinfection with FotoSan. In the second group was performed the endodontic treatment with the standard protocol of irrigation - 2.5% sodium hypochlorite solution and 17% EDTA. After that, the root canals are dried with sterile points, and a second microbiological sample is taken. Results: In all compared pairs, there was no significantly different effect regarding the number of microorganisms. Conclusions; The disinfection with NaOCl has the strongest antimicrobial effect in this study. Second place is occupied by PAD with FotoSan. We believe that the established antimicrobial effect of PAD make the method appropriate as complementary to routine endodontic treatment.

The Effectiveness of Corneal Epithelial Debridement Performed with an Alcohol-Impregnated Sponge.

To evaluate the clinical outcomes of patients who underwent corneal surgery with debridement of epithelium by localised application of an alcohol-impregnated sponge instead of the usual alcohol reservoir method. This study retrospectively included 52 eyes of 27 patients who underwent LASEK (laser-assisted subepithelial keratectomy) and CXL (cross-linking) surgery after application of this alcohol-assisted debridement method between January 2019 and April 2019. Twenty-four patients who underwent LASEK and three patients who underwent CXL surgery were included in this study, which comprised a total of 52 eye operations. Epithelial debridement was performed after placing a 20% ethanol-impregnated sponge on the cornea for 20 seconds. The mean pachymetry value was 509.40 ± 30.37 µm, the mean preoperative spherical equivalent was - 2.14 ± 1.02 dioptres, and the highest myopia and astigmatism values were - 4.25 dioptres and - 2.75 dioptres, respectively. It was seen that the corneal epithelium was completely and easily debrided in a size identical to that of the applied sponge. Complete debridement of the corneal epithelium can be performed quickly, safely, and easily with this specially prepared sponge.

Limberg Flap Method for Pilonidal Sinus Disease

Sacrococcygeal pilonidal sinus disease is a common chronic inflammation of the natal cleft and is mainly seen in young adults. Authors of some earlier works regarded the condition as congenital. Recently, it has become widely accepted that the condition is acquired, and thought to originate from hair follicles. Many treatment options has described in literature, thus in this study we present our results with Limberg flap reconstruction on pilonidal sinus disease. 38 patients underwent limberg flap reconstruction for pilonidal sinus disease enrolled in this study. No bleeding has occur intra and postoperatively, 2 patients developed urinary retention (%5.2), on 1 patient with diabetes mellitus wound dehiscence has developed which has treated with 3 week long simple debridement method (%2.6). 1 patient developed superficial infection treated with basic antibiotics (%2.6). No other complications has developed. No recurrence has seen in -mean -11.2 month period. We think limberg flap closure on pilonidal sinus disease is an effective and safe option.

Changes in the surface topography and element proportion of clinically failed SLA implants after in vitro debridement by different methods.

To evaluate the surface topography and element proportion changes in clinically failed implants after different modalities in vitro debridement and to compare the cleaning effect of different method combinations. Thirty clinical failed implants were treated by different debridement methods in vitro as follows: Group 1: physiologic saline irrigation; Group 2: glycine powder air polishing; Group 3: glycine powder air polishing+ethylenediaminetetraacetic acid (EDTA); Group 4: polyetheretherketone (PEEK) tip ultrasonic scaling; and Group 5: PEEK tip ultrasonic scaling+EDTA. The relative contaminated area reduction (RCAR), visual analogue scale (VAS, the higher value means, the better cleaning effect) and surface roughness were assessed using scanning electron microscopy (SEM), stereoscopic microscopy (SM) and white light interferometry (WLI). Surface chemistry was determined by energy dispersive spectroscopy (EDS). Group 4 and Group 5 showed higher RCARs (82.90%, 82.89%), VAS scores (2.61, 2.33) and roughness reductions (-0.85μm, -1.80μm). Group 3 attained the highest decrease of C% (carbon, -26.67%), O% (oxygen, -13.71%) and N% (nitrogen, -5.66%), and the highest increase of Ti% (titanium, 49.67%). PEEK remnants were detected on the implant surface of Groups 4 and 5. Within the limitation of the present in vitro design, PEEK tip ultrasonic scaling was more effective in eliminating visible contamination, while glycine powder air polishing combined with EDTA treatment was more conducive to expose the original surface element distribution. Both methods have their own advantages in decontamination, but none of them could reconstruct the surface as the pristine implant.

Frequency of sharp wound debridement in the management of diabetes-related foot ulcers: exploring current practice

BackgroundConservative sharp wound debridement (CSWD) is fundamental to wound bed preparation. Evidence-based practice guidelines strongly recommend frequent CSWD of diabetes-related foot ulcers (DFU) based on expert opinion and observational studies which suggest that more frequent debridement is associated with better healing outcomes.AimTo document current practice with regards to CSWD of DFU and whether this is performed at every visit, how often and what factors determine debridement frequency.MethodSurvey data were collected and managed using REDCap electronic data tools, a secure, web-based application. The survey was distributed through podiatry managers and relevant clinical networks between October 2017 and February 2018.ResultsOne hundred clinicians opened the survey and seventy-five surveys were completed by n = 53 NSW Health (Australia) employed podiatrists (representing 41% of all NSW Health podiatrists), 11 privately practicing podiatrists, and 11 nurses. Most (n = 47) worked in metropolitan areas versus regional/remote (n = 28). CSWD was the most frequently used debridement method, performed at every visit by most (84%) of podiatrists. Callus, slough and infection presence were the top 3 most important determinants of frequency, with staff time (a limiting factor) ranking 4th. Regional/remote podiatrists practiced less frequent debridement compared with those in metropolitan areas (debridement every 2 weeks or less = 71% regional podiatrists versus 45% metropolitan podiatrists) (p = 0.024).Conclusion and clinical implicationsCSWD was the predominant form of debridement used with debridement occurring at every treatment visit for most of the clinicians surveyed. Debridement frequency was determined by clinical wound indications and staffing resources, with regional/remote podiatrists providing debridement less often than their metropolitan colleagues.

Экспериментальная модель хронического очагового остеомиелита для исследований in vivo

Introduction. The article describes an experimental model of chronic suppurative osteomyelitis in a rabbit. As new therapeutic and diagnostic algorithms for the supervision of patients with osteomyelitis appear, there is an growing need to compare the methods of surgical debridement and plasty of bone defects in an infectious process, in order to create experimental standardized pathological conditions as close to the clinical course of the disease in humans as possible. The aim of the study was to develop an experimental model of a standardized chronic purulent bone cavity, suitable for a comprehensive assessment of surgical debridement effectiveness and osteoplastic properties of bone substitute materials. Materials and methods. A standardized defect of the tibia in 24 rabbits was formed. The Staphylococcusaureus strain was used as an infectious agent. A dynamic assessment of the main indicators of blood counts in animals was carried out. The formation of chronic osteomyelitis was evaluated using radiography, com-puted tomography methods and histological studies. Results. It was shown that purulent bone wound developed in experimental animals with the technique cre-ated, and a defect with signs of a chronic purulent-inflammatory process was demonstrated. Conclusion. The proposed model of chronic osteomyelitis is reproducible. Operational flexibility and identi-cal in size and location bone defects allow to use this model in new osteoplastic material research. Keywords: chronic osteomyelitis, experiment, experimental animals

Epi-Bowman keratectomy versus alcohol-assisted photorefractive keratectomy: wound healing and complications

Purpose:In Epi-Bowman Keratectomy™ (EBK), a new dynamic multi-blade single-use device (Epi-Clear™, Orca Surgical, Israel) is utilized to remove the epithelium by sweeping movements across the corneal surface. Epithelial cells are discarded. Alcohol or other chemical agents are not utilized. We wanted to compare clinical results of Epi-Clear photorefractive kertectomy (PRK) to alcohol-assisted PRK.Study design:Retrospective, comparative study.Methods:Consecutive case series: Adult patients seeking laser vision correction of myopia or myopic astigmatism without ocular diseases or prior surgery were included. The Epi-Clear PRK group comprised 50 consecutive eyes of 27 patients and the PRK group 50 eyes of 25 patients.Results:No intraoperative complications occurred. Epi-Clear PRK: At day 1, day 4, and 3 months, uncorrected distance visual acuity (UDVA) was 0.41/0.47/0.93 (decimal scale); epithelial defect diameter was 4.7/0.2/0 (mm); pain level was 3.8/0.3/0 (visual analogue scale, 0–10), respectively. At 3 months, efficacy index was 0.86 and spherical aberrations were unchanged. Three eyes (6%) showed (presumably sterile) infiltrates. PRK: At day 1, day 4, and 3 months, UDVA was 0.56/0.46/1.15; epithelial defect diameter was 6.3/0.2/0 (mm); pain level was 5.0/0.3/0, respectively. At 3 months, efficacy index was 1.1 and spherical aberrations were unchanged.Conclusion:The new method of epithelial debridement with Epi-Clear before laser ablation seems to offer fast epithelial removal without nicking Bowman’s layer (as observed with the laser microscope). However, we found significantly inferior results of Epi-Clear PRK compared to alcohol-assisted PRK. Furthermore, after Epi-Clear PRK corneal infiltrates as a new type of postoperative complication were observed.

Combination of minimally invasive approaches of the debridement in treatment of the patient with infected necrotizing pancreatitis

This article presents the clinical case of using combination of minimally invasive approaches of debridement in patient with infected necrotizing pancreatitis. The decision of using minimally invasive approaches: endoscopic transluminal pancreatic necrosectomy combined with percutaneous catheter drainage under US-navigation and video-assisted retroperitoneal debridement was made, due to the giant necrotic cavity, containing huge amount of necrotized tissues (diagnosed by instrumental methods—CT, US).Discussion: Acute necrotizing pancreatitis is still the important surgical problem, because of the great number of different complications and high level of mortality, despite achievements in the treatment of this group of patients. Many articles, focused on the use of modern minimally invasive approaches in case of infected necrotizing pancreatitis, have been published. Moreover, the combination of minimally invasive approaches is using in managing of some patients for better debridement (including minimally invasive methods of debridement).Conclusion: The combination of minimally invasive ways of debridement in patients with necrotizing pancreatitis is an effective surgical tactic, which leads to better results in treatment.

English

BACKGROUND Wet to dry normal saline mechanical debridement is the most common, cost effective debridement method, which is used widely,1 including in our hospital setup in wound care management. Papaya is an enzymatic debriding agent which has been in use for many years.2 We wanted to compare the effectiveness of papaya and normal saline in healing of ulcers and evaluate the role of papaya dressing in wound debridement, granulation tissue formation, reduction in ulcer size, and ulcer healing. METHODS This is a comparative interventional study of 100 patients done at Sri Venkateshwara Medical College, Tirupathi, from December 2017 to December 2018. Patients were selected and randomized into two groups - Group I (treated with papaya) and Group II (treated with normal saline). Patients were clinically assessed at the time of inclusion and daily dressing was done. Patients were assessed weekly for 4 weeks and response noted regarding slough reduction, granulation tissue formation, reduction in ulcer size, and overall response to treatment. Additional treatment and follow, up to 3 months were recorded. RESULTS The disappearance of slough / necrotic tissue was significant in the papaya group in the third and fourth week when compared to the normal saline group. 23 patients in the normal saline group, and 27 patients in the papaya group did not require any additional treatment. 22 patients underwent SSG in the normal saline group and 19 patients in the papaya group. Five patients underwent secondary suturing in the normal saline group and four patients in the papaya group. 23 patients in the normal saline group and 27 patients in the papaya group did not require any additional treatment. CONCLUSIONS Papaya is a better and effective debriding agent in comparison to wet to dry normal saline dressing and it also promotes faster granulation tissue formation. Overall response to treatment with papaya is good. KEYWORDS Papaya Dressing, Normal Saline Dressing, Ulcer Healing

A Biomechanical Evaluation of the Tibia after Retrograde Intramedullary Reaming

Category:Hindfoot; Ankle; Ankle Arthritis; Basic Sciences/Biologics; TraumaIntroduction/Purpose:Autologous bone graft is an important tool in the foot and ankle surgeon’s arsenal, and remains the gold standard despite the release of new biologics. The Reamer-Irrigator-Aspirator (RIA) system has become an option for local intramedullary bone graft harvest. Evidence supports the quality of graft and safety of RIA in the femur, and some series have demonstrated its value in tibial reaming for hindfoot fusion. However, there has been no analysis of the mechanical effects of the system on the tibia. The purpose of this study is to investigate the effect of retrograde intramedullary reaming on the mechanical properties of cadaveric tibias, with the hypothesis that this will produce no significant difference in torsional strength between groups.Methods:Intact, fresh frozen tibias were obtained for testing, totaling 11 matched pairs. One tibia was chosen for reaming from each pair with pre-test randomization. The selected tibia was reamed in a retrograde fashion over a guidewire to 12mm, which is the smallest diameter RIA device available. Each tibia was potted and mounted in a custom jig for testing on a servohydraulic test frame. Each specimen was first tested non-destructively for compressive properties using standardized loading rates. Each specimen was then loaded in torsion under constant angular velocity of 9˚/second until failure or the limit of the load cell was reached. Mechanical properties were determined from the load-displacement curve and compared between reamed and unreamed matched pairs using paired samples statistics, with statistical significance set at p=0.05.Results:Specimens were of mean age 56 (range 39-67) years, with 55% being female. The mean compressive stiffness of reamed (560.4 +- 111.7 N/mm) and unreamed (628.2 +- 117.2 N/mm) tibias were not statistically different (p = 0.167). Nine of the reamed specimens and 10 of the unreamed specimens fractured during torsional testing. Torsional testing for stiffness (178.4 Nm/rad +- 59.4 vs 168.1 +- 40.8, p=0.370), rigidity (50.4 Nm2/rad +- 19.1 vs 47.0 +- 13.7, p=0.331), and ultimate load capacity (71.2 Nm +- 24.3 vs 71.9 +- 20.5, p=0.880) showed minimal differences between reamed and unreamed specimens, respectively.Conclusion:Mechanical testing identified no statistically significant differences in torsional or compressive properties of our cadaveric tibias after intramedullary reaming. There was a trend towards decreased compressive stiffness, but this is not a common mechanism of fracture. Our findings suggest that the use of the smallest size RIA system in the tibia does not drastically alter the mechanical properties or require prophylactic fixation. The RIA can be used safely as a method of bone graft harvest or intramedullary debridement in the tibia, as long as appropriate technique is used to avoid eccentric reaming or excessive blood loss.

Thirty-nine cases of stage 4 pressure ulcers treated by a two-stage method of debridement and skin flap transfer

From September 2013 to October 2018, 39 patients (28 males and 11 females, aged 21 to 76 years) with stage 4 pressure ulcers were admitted to the General Hospital of Xinjiang Military Command. The area of pressure ulcers ranged from 2 cm×2 cm to 20 cm×12 cm on admission. The two-stage method of debridement and skin flap transfer was exploited to repair the wounds. In the first stage, a thorough debridement was performed (26 cases underwent debridement once, 10 cases twice, and 3 cases for three times). The skin flap transfer surgery was conducted in the second stage after 6 to 12 days (local skin flap for 16 cases, vascularized island flap for 8 cases, fascial flap for 5 cases, gluteus maximus flap for 5 cases, and biceps femoris flap for 5 cases), with flap area of 4 cm×2 cm to 16 cm×10 cm. Some donor sites were closed by direct suture and the other donor sites which can not be sutured were covered by medium-thickness skin graft from the lateral thigh. All the pressure ulcers of 39 cases were healed with no sinus. During follow-up of 6 months to 5 years, no recurrence of pressure ulcer at the surgical site was observed; the flaps achieved soft texture and good appearance. Thus, the two-stage method of debridement and skin flap transfer achieved good long-term curative effect and could be a preferable option for treating stage 4 pressure ulcers.

Comparison between four different implant surface debridement methods: an in-vitro experimental study.

Peri-implantitis treatment is a very challenging topic to discuss. What is certain is that preventive/supportive therapy plays a key-role in peri-implant tissues' health maintenance and non-surgical implant surface mechanical debridement remains one of the solid pillars in the therapeutic pathway. In this perspective, many surface decontaminating methods have been proposed and tested to remove hard and soft bacterial deposits. The aim of this study was to compare four different commonly used non-surgical implant debridement methods in terms of cleaning potential in vitro, using a peri-implant pocket-simulating model. Sixty-four dental implants were ink-stained and placed into a simulated peri-implant pocket. Samples were then divided into four groups and treated with different debridement methods: stainless-steel ultrasonic tip (PS), peek-coated ultrasonic tip (PI), sub-gingival air-polishing with erythritol powder (EHX) and sub-gingival air-polishing with glycine powder (GLY). For each treatment group, half of the samples were treated for 5 seconds and the other half for 45 seconds. High-resolution images were taken using a digital microscope and later analyzed with a light processing software for measuring the cleaned area percentage (ink-free). Two different images were captured for every sample: a first image with the implant positioned perpendicular to the microscope lenses (90°) and a second one with the implant placed with a 45° vertical angulation, with the smooth neck towards the ground. Percentage of removed ink was statistically modelled using a generalized linear mixed model with the implant as a random (clustering) factor. A paired comparison between all treatments in terms of debridement potential (cleaned area percentage) was performed. In 5s and with 90° sample angulation EHX/PS comparison showed an odds ratio of 2.75 (P<0.001), PI/EHX an OR of 0.20 (P<0.001), GLY/PS an OR of 2.90 (P<0.001), PI/GLY an OR of 0.19 (P<0.001) and PI/PS an OR of 0.56 (P=0.105). With the same sample angulation and 45s treatment time, the OR was 6.97 (P<0.001) for EHX/PS comparison, 0.14 (P<0.001) for PI/EHX comparison, 4.99 (P<0.001) for GLY/PS, 0.19 (P<0.001) for PI/GLY and 0.95 for PI/PS (P =0.989). With 5s of treatment time and 45° sample angulation, EHX/PS comparison shows a 3.19 odds ratio (P<0.001), PI/EHX a 0.14 odds ratio (P<0.001), GLY/PS a 3.06 odds ratio (P<0.001), PI/GLY a 0.15 odds ratio (P<0.001) and PI/PS a 0.46 odds ratio (P=0.017). With the same sample angulation but 45s treatment time, EHX/PS comparison produced an odds ratio of 4.90 (P<0.001), PI/EHX an OR of 0.20 (P<0.001), GLY/PS an OR of 8.74 (P<0.001), PI/GLY an OR of 0.11 (P<0.001) and PI/PS an OR 0.96 of (P =0.996). Among the four treatments considered, air-polishing therapy represents the best one in terms of ink removal from the implant surface. Furthermore, increasing the treatment time to 45 seconds, air-polishing resulted considerably more efficient.

Clinical effectiveness of super pulsed carbon dioxide fractional laser debridement surgery in treating chronic wounds

Objective: To investigate the clinical effectiveness of super pulsed carbon dioxide fractional laser debridement surgery on the treatment of chronic wounds. Methods: From December 2018 to May 2019, 37 patients with chronic wounds who met the inclusion criteria were admitted to the Affiliated Hospital of Southwest Medical University for a prospective randomized controlled study. Using the random number table, the patients were divided into surgical debridement group (19 patients, 4 males and 15 females, aged (58±16) years, 25 wounds) and laser debridement group (18 patients, 9 males and 9 females, aged (58±10) years, 23 wounds). In patients of surgical debridement group, oedematous and aging granulation tissue was scraped from the wound by scalpel handle or curet, and the residual necrotic tissue was removed by sharp surgical instruments. In patients of laser debridement group, oedematous and aging granulation tissue and necrotic tissue was removed by super pulsed carbon dioxide fractional laser therapeutic machine, laser gasification debridement was performed repeatedly till fresh normal tissue layer observed. In patients of the two groups, according to the wound in the first 3 d after the first debridement, debridement dressing was performed twice at least as before, then wound debridement dressing was performed once every 1 to 4 days as before according to the wound conditions. The wound healing rates on 7, 14, 21, and 28 d after the first debridement were calculated. The positive rates of bacterial culture of wounds before and after the first debridement were calculated. The color and texture of the wound granulation tissue before the first debridement and on 7, 14, and 28 d after the first debridement were observed and scored. The pain scores before every debridement, during every debridement, and after every debridement dressing change were evaluated by visual analogue scale. The times of debridement dressing change were recorded. Data were statistically analyzed with two independent sample t test, analysis of variance for repeated measurement, Fisher's exact probability test, Mann-Whitney U test, and Bonferroni correction. Results: (1) On 7, 14, 21, and 28 d after the first debridement, the wound healing rates of patients in laser debridement group (29.5% (24.1%, 36.0%), 47.1% (42.7%, 62.4%), 71.4% (62.2%, 76.8%), and 88.6% (79.2%, 96.3%) were significantly higher than those of surgical debridement group (1.6% (1.0%, 12.8%), 12.7% (2.0%, 16.6%), 24.5% (8.9%, 45.5%), 43.9% (23.2%, 70.8%), Z=3.477, 3.553, 2.721, 2.193, P<0.05 or P<0.01). (2) Before the first debridement, the positive rates of bacterial culture of wounds in patients of laser debridement group and surgical debridement group were 92% (23/25) and 91% (21/23), respectively, which were similar (P>0.05). After the first debridement, the positive rate of bacterial culture of wounds of patients in surgical debridement group was 64% (16/25), which was significantly higher than 13% (3/23) of laser debridement group (P<0.01). (3) On 7, 14, and 28 d after the first debridement, the scores of color and texture of wound granulation tissue of patients in laser debridement group were significantly higher than those of surgical debridement group (Z=3.420, 5.682, 6.142, 4.461, 5.337, 4.458, P<0.01). (4) The pain scores during every debridement and after every debridement dressing change in patients of laser debridement group were significantly lower than those of surgical debridement group (t=2.847, 5.046, P<0.05 or P<0.01). (5) The time of debridement dressing change in laser debridement group was 8.0 (7.0, 10.0) times, which was significantly less than 10.0 (9.5, 12.5) times in surgical debridement group (Z=2.261, P<0.05). Conclusions: Compared with traditional surgical debridement method, super pulsed carbon dioxide fractional laser debridement surgery is more effective in treating patients with chronic wounds. Laser debridement makes the wound healing more efficiently with reduced pain and better infection control; significantly reduces the number of dressing changes, and is especially suitable for the wound treatment in outpatients.

Advanced technologies for treatment of infected pancreatic necrosis: differentiated approach

This work is based on analysis of publications devoted to the problem of surgical approach to treatment of acute pancreatitis over the last 30 years. The main aim of this review is to identify the key steps of evolution of surgical approach to treatment of infected pancreatic necrosis and also to determine the most promising approach among existing methods. The analysis of the most modern clinical recommendations adopted in different countries of the world, as well as the search for such problems, the solution of which will be the main task of world medical science in the near future, is carried out. It has been established that medical communities of different countries give preference to minimally invasive methods of debridement: percutaneous and transluminal endoscopic drainage. According to the most advanced recommendations, the method of choice for surgical treatment of infected pancreatic necrosis is transluminal endoscopic drainage, with inefficiency – percutaneous puncture drainage. The main idea that defines the search vector for treatment methods for the disease is the recognition of the fact that all surgical approaches are aimed at achieving one goal – removing the maximum possible volume of necrotic masses with minimal damage to surrounding tissues. Only a method that satisfies both requirements can be recognized as leading.

Digital ulcers: should debridement be a standard of care in systemic sclerosis?

Digital ulcers are a serious, recurrent complication in patients with systemic sclerosis. They are often slow to heal and exquisitely painful. Local wound care, such as debridement of the wound bed, is an essential component in the management of digital ulcers in systemic sclerosis. However, digital ulcer debridement is not a standard of care, and there is substantial international variation in the use of this approach. In this Viewpoint, we discuss the assessment of the wound bed and different methods of debridement using the model of tissue management, infection and inflammation, moisture control, and wound edge or epidermal advancement, known as TIME. We highlight the challenges in standard practice and the need for research into local wound care for this type of ulceration, before suggesting a potential roadmap to develop a standardised approach to support ulcer debridement in systemic sclerosis. Debridement might be the missing component in optimising the management of digital ulcers and we propose that the approach should be rigorously investigated as a standard of care in this common complication of systemic sclerosis.

Effect of a single initial phase of non-surgical treatment of peri-implantitis: Abrasive air polishing versus ultrasounds. A prospective randomized controlled clinical study

BackgroundNon-surgical treatment of peri-implantitis includes a correct mechanical debridement of the implant surface to reduce the inflammation and recondition the soft tissues. The aim of the study was to evaluate the results of a single phase of non-surgical therapy by comparing the effect of curettes and ultrasounds versus curettes and abrasive air polisher (Air-Flow) in the peri-implant tissue conditions, and patient satisfaction. Material and MethodsA double-blind randomized and controlled prospective clinical study was conducted on patients in peri-implant maintenance phase diagnosed of peri-implantitis treated in the Oral Surgery Unit of the Stomatology Department of the Faculty of Medicine and Dentistry of the University of Valencia, between September of 2017 and May of 2018. They were divided into 2 groups: Group 1: curettes and ultrasounds, and Group 2: curettes and Air-Flow. The clinical and radiological baseline parameters were evaluated after 3-weeks of treatment, as well as patient satisfaction. ResultsThe sample included 34 patients. Group 1 (17 patients, 38 implants) and Group 2 (17 patients, 32 implants). All the variables improved statistically significantly after treatment in both groups, with the exception of recessions and keratinized mucosa and bone loss that did not vary. When comparing both groups, the type of treatment did not influence the majority of the variables, with the exception of the plaque index (p=0.011) and modified bleeding index from the palatine (p=0.048), which reduced statistically significant in the group 2, as well as the patient satisfaction which was higher in the group 2 (p<0.001). ConclusionsAn initial phase of non-surgical treatment achieves an improvement of the peri-implant clinical parameters, thought the method of debridement used seems not to influence. Key words:Peri-implantitis, peri-implant disease, non-surgical treatment, air-abrasive device, mechanical debridement.

Delayed Primary Closure of the War Wound Versus Primary Closure

War wound is considered as a dirty wound and is liable to get infected and risk the trauma patient life if not properly managed. Along years of my practice in the field of war trauma surgery since 1994, I have met lots of war wounded patient suffering from infected wound or even prolonged wound infection e.g., soft tissue infection and bone infection. Wound debridement alone is not enough, at the beginning of my experience with war wound, many cases got infection in spite of wound debridement before primary closure of the wound. After getting in contact with international committee of red cross in 1996, I started to follow the ICRC guidelines of war wound management which is composed of many steps in logical order for the method of proper wound debridement followed by delayed primary closure of the wound instead of primary closure. Using ICRC method of war wound management and delayed primary closure, I have never suffered a case of wound infection, unless the debridement was not done properly.

Slough: what does it mean and how can it be managed

The purpose of this paper is to provide an overview of the formation of slough on the wound bed. The impact slough has on wound healing will also be explored. There are several wound cleansing products which can be used for the safe removal of slough, and several different methods of debridement - including autolytic, conservative sharp, surgical, ultrasonic, hydrosurgical and mechanical - as well as several therapies which can be used, including osmotic, biological, enzymatic dressings and monofilament fibre pads. These various methods will be described.

Surgical Treatment of Chronic Osteomyelitis

Introduction.In this study, we analysed the results of applying various surgical methods in the combined treatment of inflammatory diseases of bones and joints.Materials and methods.The work was based on data from a multi-dimensional cohort study using non-concurrent (historical) control. A retrospective study included the analysis of medical records covering the period of 2009–2016 (1059 patients). A prospective study consisted in analysing the effectiveness of modern surgical methods in the combined treatment of inflammatory diseases of bones and joints in patients hospitalised to the Septic Surgery Department of the G.G. Kuvatov Republican Clinical Hospital (Ufa, Russia) in 2017–2018 (285 patients).Results and discussion.An analysis of the authors’ own data revealed that injuries (73.21%) and infectious complications after receiving surgery on bones and joints (15.03%) are the most common causes of osteomyelitis. In most cases, the following list of measures is optimal for diagnosing suspected osteomyelitis of various etiologies: X-ray, general clinical tests supplemented by the fistulography or CT of the affected area prior to surgery, as well as the examination of surgical material after surgery. The use of modern methods for surgical debridement and surgical repair of bone defects in the combined treatment of patients with chronic osteomyelitis can significantly reduce the relapse rate. It is recommended that patients with osteomyelitis be treated at large in-patient surgical facilities, which include a specialised department for the treatment of surgical infections and corresponding support services.Conclusion.Apparently, there is no one most optimal method for treating osteomyelitis. The optimal effect in the treatment of osteomyelitis is achieved through a personalised set of therapeutic measures using the following methods: laser vaporisation, negative-pressure wound therapy, ultrasonic cavitation in the focus of inflammation, as well as surgical repair of the post-trepanation bone defect or wound.