Efficacy of debridement and primary closure of contaminated wounds: a comparison of methods

To Debride or Not to Debride: A Review of Wound Management for Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are immune-mediated skin reactions with high mortality as a result of severely compromised skin barrier function. Currently, there is no consensus on the topical management of these conditions. Some advocate for surgical debridement of affected skin as a means of preventing infection and facilitating reepithelialization with synthetic and biological wound coverage. Others prefer a conservative approach that relies on leaving the blistered skin in situ. A consensus is lacking, primarily due to the rarity of the disease and the lack of high-quality evidence supporting one particular form of management. The goal of this review is to explore and compare the two treatment approaches for SJS and TEN, namely conservative management and surgical debridement.

Dilute Povidone-Iodine Solution Soaking Is Ineffective in Improving Outcomes of Necrotizing Fasciitis Caused by Diabetic Foot

ABSTRACT

Wound soaking is a physical debridement method that helps reduce bacterial colonization and consequently promotes wound healing. Although soaking in povidone-iodine solution was ineffective in reducing bacterial colonization in acute trauma wounds, there is still a lack of evidence supporting the efficacy of this method in treating severe soft tissue infection. This study aimed to explore the effects of wound soaking in 1% dilute povidone-iodine solution on necrotizing fasciitis caused by diabetic foot ulcers. We retrospectively reviewed and finally included 153 patients who were admitted because of diabetic foot ulcers after undergoing fasciotomy for necrotizing infection from January 2018 to December 2021. Results showed no statistical difference in the outcomes between patients in the soaking and nonsoaking groups. End-stage renal disease (P = 0.029) and high serum C-reactive protein level (P = 0.007) were the only independent factors for below-knee amputation in the univariate and multivariate logistic regression analyses. Therefore, soaking diabetic wounds with severe infection in 1% dilute povidone-iodine solution may not reduce the hospital length of stay, risk of below-knee amputation, and readmission rate.

Debridement of burn wounds with a water jet surgical tool

A new instrument, the Versajet system, based on fluid jet technology has recently been advocated as an alternative to standard surgical excisional technique for burn wounds. In this paper we describe our experience with this tool, the technique employed as well as its clinical feasability for debriding partial thickness burn wounds. Seventeen patients were evaluated for clinical efficacy of debridement of their burn wounds using the Versajet system. Burn wound areas of between 0.5 and 5% total body surface (TBSA) involving the face, arm, hand, leg and foot underwent debridement using the Versajet system. The Versajet system was able to sufficiently debride superficial partial thickness and mid-dermal partial thickness wounds for subsequent placement of Biobrane. Deeper partial thickness wounds could be excised for successful autografting. The Versajet system demonstrated some particular advantage in the surgical treatment of superficial to mid-partial thickness burns in areas like the face, hand and foot which can often be difficult to reach and contour with conventional modalities.

Early Experience Using Low-Frequency Ultrasound in Chronic Wounds

Periodic wound debridement promotes healing in chronic wounds. Low-frequency ultrasonic debridement (LFUD) is a promising adjunct to wound care, which offers relatively painless debridement and bacterial biofilm destruction. We performed LFUD on 17 patients over 8 months, with a minimum follow-up of 3 months. Nine of the wounds (53%) healed primarily or with the aid of a skin graft. Six additional patients (35%) experienced a wound-size reduction of at least 50%. The remaining 2 patients (12%), one with sickle cell anemia and one with a venous stasis ulcer, had reductions in wound area of 20%-30%. None of the patients required initiation of antibiotic treatment after starting LFUD. LFUD has had an early favorable experience in our institution. Further randomized clinical studies are required to better define the mechanism of action and the patient populations most appropriate for this modality.

Optionen des Debridements in der Therapie chronischer Wunden. Options for debridement in the therapy of chronic wounds

Debridement is defined as the removal of non-vital tissue from wounds. In chronic wounds, debridement means the elimination of necrosis as well as the clearing away of wound dressings, foreign bodies, and other non-vital substances. Sufficient debridement represents one basic prerequisite for a non-delayed wound-healing process. In addition to treating the causal factors for delayed wound healing, debridement should be the first step in an adequate phase-adapted wound-bed preparation for chronic wounds. This report aims to review the different options available in the execution of debridement in chronic wounds. The following therapeutic measures are available for the debridement of chronic wounds: surgery, maggot therapy, laser, ultrasound, hydrotherapy, wet-to-dry method, autolysis, proteolytic enzymes, osmotic or chemical debridement. There is no single correct debridement for all patients! Patients are individuals and therefore different methods of debridement may make sense. Which therapeutic option is chosen is determined by multiple factors. Moreover, depending on the wound milieu, the successive application of different methods can be useful.

[Wound bed preparation of chronic wounds with ultrasound]

The use of different low dose ultrasound systems is an innovative and effective alternative strategy of treatment in wound bed preparation of different chronic wounds. The handling of the ultrasonic systems is easy to learn, their use is safe and little additional equipment is required. Induction of the so called cavitation phenomenon seems to be a major effect which permits selective debridement and reduction of microorganism colonisation. While the suggestion is that granulation tissue is promoted and wound healing accelerated, there are few well documented evidence-based data. Additional randomized controlled trials are needed before the therapeutic efficacy of ultrasound in this clinical setting can be evaluated.

Ultrasonic debridement of contaminated facial wounds

Contaminated facial wounds can be debrided with the Piezon ultrasonic scaler. The fine scaler tip provides efficient, rapid, precise and thorough removal of ingrained subdermal dirt and grit without the loss of viable facial tissue.

Debridement of burn wounds with a surgical ultrasonic aspirator

Ultrasonic ablation of tissue by the surgical ultrasonic aspirator (SUA) is an established technique in neurosurgery and hepatobiliary surgery. We report the first use of SUA in the debridement of burn wound in three patients. Our initial experience suggested that SUA allows meticulous wound debridement and cleansing with minimal bleeding and destruction of normal tissue and, therefore, is an extremely useful surgical instrument to add to the armamentarium of the burn surgeon.