Débridement of the noninfected wound

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

doi:10.1016/j.jvs.2010.06.006

Cited by 37 publications

(23 citation statements)

References 48 publications

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“…11 Regular wound debridement has been described to improve wound healing by not only removing dead, damaged, and infected tissue from the wound bed but also by removing the excess of proteases, inflammatory mediators, and bacterial biofilms. 35,36 Proteases in chronic wounds have been described to degrade matrix proteins 37 and growth factors (e.g., plateletderived growth factor, epidermal growth factor, and vascular endothelial growth factor). 38 In line with this, we detected only moderate amounts of bFGF and TGF-b.…”

Section: Discussionmentioning

confidence: 99%

Simple wound exudate collection method identifies bioactive cytokines and chemokines in (arterio) venous ulcers

Kroeze

Vink

Boer

et al. 2012

Wound Repair Regeneration

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A major challenge for clinicians treating (arterio) venous leg ulcers is to decide between standard therapy and advanced interventions. Here, we developed a simple method to collect human material representative of the ulcer wound bed, which can be used to identify biomarkers for prognostic test development. Superficial surgical debridement was performed using a small vidal curette during the weekly visit to the outpatient clinic. Moist, easily removable debridement material essentially blood free (including necrotic and nonviable slough) was collected from the surface of the ulcer. The amount ranged from 5.5 mg to 78 mg material per ulcer. Seventeen cytokines, chemokines, and growth factors were extracted and analyzed by enzyme-linked immunosorbent assay (concentration range: 0.0005-78 ng/mg total protein). Notably, CXCL8 was by far the most abundant protein present. Inflammatory mediators were more abundant than anti-inflammatory mediators (e.g., interleukin (IL)-10 and transforming growth factor-β1). Bioactivity assays showed chronic wound extracts to be capable of stimulating fibroblast migration in a chemokine-dependent manner and also capable of stimulating healthy cells within skin substitutes to secrete wound healing mediators (CCL2, CXCL1, CXCL8, IL-6) in an IL-1α dependent manner. Collection of debridement tissue enables investigation of the ulcer environment in an easy noninvasive manner that may be suitable for prognostic test development.

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Section: Discussionmentioning

confidence: 99%

Simple wound exudate collection method identifies bioactive cytokines and chemokines in (arterio) venous ulcers

Kroeze

Vink

Boer

et al. 2012

Wound Repair Regeneration

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“…the removal of materials incompatible with healing, can substantially accelerate the complex wound healing process [19]–[21]. Even if superinfections are controlled with antibiotics, chronic wounds can be caught in a chronic inflammatory phase and debridment is then required to convert the chronic wound bed into an acute wound and mediate healing through the stages of inflammation, proliferation and maturation [20]. This may also apply for BU lesions which show massive infiltration during antibiotic treatment and may subsequently be arrested in a chronic stage without the chance of proper healing.…”

Section: Discussionmentioning

confidence: 99%

Histopathological Changes and Clinical Responses of Buruli Ulcer Plaque Lesions during Chemotherapy: A Role for Surgical Removal of Necrotic Tissue?

Ruf

Sopoh²,

Brun

et al. 2011

PLoS Negl Trop Dis

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BackgroundBuruli ulcer (BU) caused by Mycobacterium ulcerans is a necrotizing skin disease usually starting with a subcutaneous nodule or plaque, which may ulcerate and progress, if untreated, over months and years. During the currently recommended antibiotic treatment with rifampicin/streptomycin plaque lesions tend to ulcerate, often associated with retarded wound healing and prolonged hospital stays.Methodology/Principal FindingsIncluded in this study were twelve laboratory reconfirmed, HIV negative BU patients presenting with plaque lesions at the CDTUB in Allada, Benin. Punch biopsies for histopathological and immunohistochemical analysis were taken before start of treatment and after four to five weeks of treatment. Where excision or wound debridement was clinically indicated, the removed tissue was also analyzed. Based on clinical judgment, nine of the twelve patients enrolled in this study received limited surgical excision seven to 39 days after completion of chemotherapy, followed by skin grafting. Lesions of three patients healed without further intervention. Before treatment, plaque lesions were characterized by a destroyed subcutis with extensive necrosis without major signs of infiltration. After completion of antibiotic treatment partial infiltration of the affected tissue was observed, but large necrotic areas remained unchanged.Conclusion/SignificanceOur histopathological analyses show that ulceration of plaque lesions during antibiotic treatment do not represent a failure to respond to antimycobacterial treatment. Based on our results we suggest formal testing in a controlled clinical trial setting whether limited surgical excision of necrotic tissue favours wound healing and can reduce the duration of hospital stays.

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“…Regular sharp debridement is essential for periodic reduction of the bacterial load, reduction of hyperkeratotic skin, and for stimulating growth factors. Decreasing the amount of bacteria present can reduce the incidence of infection and increase healing potential . Additionally, infection may need to be controlled by oral or intravenous antibiotics.…”

Section: The Basicsmentioning

confidence: 99%

What's new in wound treatment: a critical appraisal

Garwood

Steinberg

2016

Diabetes Metabolism Res

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With the growing demand for the specialized care of wounds, there is an ever expanding abundance of wound care modalities available. It is difficult to identify which products or devices enhance wound healing, and thus, a critical and continual look at new advances is necessary. The goal of any wound regimen should be to optimize wound healing by combining basic wound care modalities including debridement, off-loading, and infection control with the addition of advanced therapies when necessary. This review takes a closer look at current uses of negative pressure wound therapy, bioengineered alternative tissues, and amniotic membrane products. While robust literature may be lacking, current wound care advances are showing great promise in wound healing.

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Débridement of the noninfected wound

Cited by 37 publications

References 48 publications

Simple wound exudate collection method identifies bioactive cytokines and chemokines in (arterio) venous ulcers

Simple wound exudate collection method identifies bioactive cytokines and chemokines in (arterio) venous ulcers

Histopathological Changes and Clinical Responses of Buruli Ulcer Plaque Lesions during Chemotherapy: A Role for Surgical Removal of Necrotic Tissue?

What's new in wound treatment: a critical appraisal

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