Bacterial bioburden of wounds: influence of debridement and negative-pressure wound therapy (NPWT)

Abstract

Objective: To clarify the role of microbiological swabs in surgical decision-making, we investigated the effect of negative-pressure wound therapy (NPWT) and serial surgical debridement on bacterial bioburden in hard-to-heal wounds and ultimately correlated them with the success of surgical closure. Method: All patients were treated with surgical debridement, jet lavage and NPWT before their wounds were finally closed. The treatment effect was assessed by correlating microbiological swabs obtained immediately after intervention with those obtained after removal of the dressings during the following surgical procedures. The result of the last microbiological swab taken before definitive surgical closure was correlated with the requirement for revision surgery. Results: We included the results of 704 microbiological swabs from 97 patients in 110 wound localisations in this monocentric, retrospective study. NPWT did not improve bacterial bioburden in 77% of cases and the duration of NPWT did not affect the result. Furthermore, no significant effect of NPWT could be found for either anaerobic (p=0.96) or aerobic bacteria (p=0.43). In contrast, surgical debridement increased bacterial load in approximately 60% of cases. If sterile wound swabs could be obtained at all, it was during the first four surgical debridements in 60% of patients; after that only 10% became sterile. Conclusions: Sterile microbiological wound swabs before surgical closure were associated with lower rates of revision surgery, while low or medium bacterial loads did not increase revision rates.

Hyaluronic Acid/Collagenase Ointment in the Treatment of Chronic Hard-to-Heal Wounds: An Observational and Retrospective Study

“…Surgical debridement is commonly used for large surface wounds that are severely infected and often require the removal of exposed infected noble structures (bones, cartilage, and tendons). This debridement is more rapid and effective compared to other complementary methods, such as VAC and OTI therapy [21,22], even though it is more invasive.…”

Application of Human Acellular Dermal Matrix with Skin Graft for Lacunar Soft-Tissue Defect of Lateral Heel after Calcaneal Fracture

“…22,23 Negative-pressure wound therapy is a wound repair modality that can be used in complex wounds and even severely infected wounds because of its good histocompatibility and continuous suction properties, which can reduce debridements, pain, and hospitalization time. [24][25][26][27] Further, NPWT increases local blood flow, reduces hematoma and edema, reduces bacterial colonization, enhances cellular activity, and improves granulation and re-epithelialization. 17 When applied to the implant area, the continuous negative pressure provides a stable pressure with uniform distribution of the matrix, thus reducing shear and providing positive wound adhesion.…”

Animal tissue-derived biomaterials for promoting wound healing

“…If this keeps happening, the wound can become chronic and stop healing. [43][44][45][46] Therefore, it is vital to remove the contaminating microbes during the inflammation phase. In recent decades, numerous antibacterial agents have been developed and the existence of antibacterial materials could be classified into the following types: antibiotics, antibacterial nanoparticles and others.…”