Debridement of the Noninfected Wound

Cornell, Rhonda S.; Meyr, Andrew J.; Steinberg, John S.; Attinger, Christopher E.

doi:10.7547/1000353

Cited by 11 publications

(8 citation statements)

References 42 publications

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“…It is well accepted that aggressive debridement and wound bed preparation are the first steps in managing a chronic wound. 26 , 27 Despite the critical role of debridement in affecting reconstructive outcomes, no objective end point for debridement has been identified. There is a lack of clear consensus on best practices in debridement, particularly the frequency and timing, and adequacy of debridement is largely based on the individual surgeon and can vary from institution to institution.…”

Section: Discussionmentioning

confidence: 99%

“…Bacteria and biofilm have long been known to complicate reconstructive efforts, and it is currently accepted that aggressive debridement and wound bed preparation is the first step in wound management. 26 , 27 Despite the critical role of debridement for reconstructive outcomes, no objective end point for debridement has been identified, and adequacy of debridement is largely based on the individual surgeon’s subjective evaluation of the wound.…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Positive Postdebridement Cultures on Local Muscle Flap Reconstruction of the Lower Extremity

Kanuri

O’Kelly

Shuck

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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Background:Local muscle flaps are a reconstructive option for wound coverage in the distal lower extremity, particularly in high-risk patients who are poor candidates for free tissue transfer. At our institution, chronic and infected wounds are managed with serial debridement before definitive reconstruction. There is a paucity of data on optimal timing for reconstruction in this patient population. This study investigates the relationship of positive postdebridement cultures (PDC) and wound closure rates at 90 days.Methods:A retrospective review of patients undergoing local muscle flap coverage of chronic distal lower extremity wounds between 2006 and 2012 was performed. All patients were managed with serial debridement until negative PDC were obtained. In some cases, PDC remained positive or exhibit delayed culture growth in the day(s) following closure. Data recorded include demographics, flap type/location, culture data, and wound closure at 90-day follow-up.Results:Of 76 patients, 60 met inclusion criteria with minimum 90-day follow-up. Despite 100% flap survival, 17 patients (28.3%) had failure of wound closure at 90 days and 22 patients (36%) had positive PDC. Multivariate analysis identified positive PDC (odds ratio, 29.6; 95% CI, 3.6–246.4; P = 0.002) and smoking (odds ratio, 8.9; 95% CI, 1.4–57.6; P = 0.02) as independent predictors of nonclosure at 90 days.Conclusions:In this series of local muscle flap coverage of distal lower extremity wounds, positive PDC were a strong independent predictor of failure of wound closure at 90 days. This study demonstrates the importance of serial debridement to negative cultures before definitive coverage in this patient population.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Effect of Positive Postdebridement Cultures on Local Muscle Flap Reconstruction of the Lower Extremity

Kanuri

O’Kelly

Shuck

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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“…Thus, the content of inflammatory cytokines in acute skin wounds could be reduced by maggot secretions, which enhance wound healing. Maggot secretion may be integrated into the materials which belonged to treatment of wounds (Michael et al, 2007;Rhonda et al, 2010). Detection of SOD activity and LPO activity in experimental rats will give us suggestion on multiple trauma patients with injury severity score.…”

Section: Discussionmentioning

confidence: 99%

The effects of maggot secretions on the inflammatory cytokines in serum of traumatic rats

Li¹,

Liu²,

Xia³

et al. 2013

Afr. J. Trad. Compl. Alt. Med.

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The objective of this study was to analyse the changes of inflammatory cytokines level in traumatic rat serum after maggot secretions intervention. Acute traumatic rats were randomly divided into three groups that included maggot secretions group, negative group, and the control group. TNF-α, IL-6, SOD, LPO levels were measured by radioimmunoassay. The experimental results showed that TNF-α, IL-6, and SOD levels in the model group were significantly increased; LPO level was decreased and showed significant differences. Thus, the content of inflammatory cytokines in acute skin wounds could be reduced by maggot secretions, which play a role in enhancing wound healing.

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“…The method of debridement should be based on the type of wound, amount and type of debris, training and expertise of the health care provider, and cost-effectiveness and time-effectiveness of the technique. 55,56 Strength of recommendation: C 15. Irrigation can serve as an extension of cleansing for debridement of superficial-to full-thickness abrasions, avulsions, blisters, incisions, lacerations, and punctures.…”

Section: Recommendationsmentioning

confidence: 99%

“…The wound should be debrided until only normal vascularized tissue remains. 54,56 Debridement can decrease the bacterial concentration within the wound bed, decreasing the bacterial bioburden 83 ; improve the function of leukocytes, reducing the risk of infection; shorten the inflammatory phase, decreasing the energy required for healing; and remove debris and tissue from the wound bed, eliminating the physical barrier to healing. 66 Technique.…”

Section: Debridementmentioning

confidence: 99%

National Athletic Trainers' Association Position Statement: Management of Acute Skin Trauma

Beam

Buckley

Holcomb

et al. 2016

Journal of Athletic Training

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Objective: To present recommendations for the cleansing, debridement, dressing, and monitoring of acute skin trauma in patients.Background: Acute skin trauma is common during participation in athletic and recreational activities. Clinical decisions and intervention protocols after injury vary among athletic trainers and are often based on ritualistic practices. An understanding of cleansing, debridement, and dressing techniques; clinical features of infection and adverse reactions; and monitoring of acute skin trauma is critical for certified athletic trainers and other allied health and medical professionals to create a local wound environment that promotes healing and lessens the risk of complications.Recommendations: These guidelines are intended to provide the certified athletic trainer and others participating in athletic health care with specific knowledge about and recommendations for the management of acute skin trauma.Key Words: abrasions, avulsions, blisters, incisions, lacerations, punctures, cleansing, debridement, nonocclusive dressings, occlusive dressings, infection, adverse reactions T raumatic injury to the skin is common among athletes participating in all sports.1 The exact frequencies of abrasions, avulsions, blisters, incisions, lacerations, and punctures are difficult to calculate because many patients do not seek medical attention after injury; for others, their activity level is initially unaffected, and the injury is not recorded on surveillance reports. Unreported skin trauma and inappropriate wound management can result in delayed healing, cross-contamination, bacterial colonization, and infection, adversely affecting the overall health and playing status of the patient. Managing acute skin trauma through appropriate cleansing, debridement, and dressing techniques can create an environment conducive to healing and lessen the risk of complications. 2,3Wound-management techniques have undergone drastic changes over the last 50 years, and other allied health care professions, organizations, and facilities have developed guidelines that serve as standards of care. [4][5][6] However, guidelines for the management of acute skin trauma by athletic trainers (ATs) are limited in the literature.1,7 The development and implementation of cleansing, debridement, and dressing techniques for acute skin trauma are critical for ATs to successfully deliver health care services to patients. The following review and recommendations provide information on the management of acute skin trauma and guidelines for ATs and other allied health and medical professionals who care for patients. RECOMMENDATIONSThis position statement is based on current research and literature with regard to the cleansing, debridement, dressing, and monitoring of acute skin trauma. We independently categorized the studies and literature using the Strength of Recommendation Taxonomy (SORT) developed by the American Academy of Family Physicians. 8 The taxonomy grades the quality of the data from the literature (level of evidence) and p...

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Debridement of the Noninfected Wound

Cited by 11 publications

References 42 publications

The Effect of Positive Postdebridement Cultures on Local Muscle Flap Reconstruction of the Lower Extremity

The Effect of Positive Postdebridement Cultures on Local Muscle Flap Reconstruction of the Lower Extremity

The effects of maggot secretions on the inflammatory cytokines in serum of traumatic rats

National Athletic Trainers' Association Position Statement: Management of Acute Skin Trauma

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