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Principles of wound care
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Debridement is the removal of non-viable tissue from the wound bed to promote wound healing (Vowden 2011). Hard to heal wounds can often contain sloughy or necrotic tissue, which acts as a barrier to wound healing and can harbour bacteria increasing the risk of malodour and infection. There are a range of debridement techniques used in the UK, which are discussed in Box 13.22: AutolyticBiologicalEnzymaticSurgicalSharpMechanicalHydrosurgery.
Selected topics
Published in Henry J. Woodford, Essential Geriatrics, 2022
Surgical intervention is usually only recommended for grade 3 or 4 ulcers in patients suitable to undergo an operation. Debridement is believed to improve wound healing by removing the necrotic tissue that has harmful effects on the wound. It has the added benefits of potentially unmasking underlying abscesses and allowing samples to be taken for culture, for example bone to diagnose osteomyelitis. Skin repair techniques include direct closure, skin grafts and the use of skin flaps.87 They are associated with high recurrence and adverse event rates in older, immobile people. Appropriate patient selection is important.
Postpartum infections
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Treatment for early-onset infection consists of antibiotic therapy such as penicillin 4 million units intravenously every 4 hours or cefazolin 2 g intravenously every 6 hours, and prompt debridement of necrotic tissue (71). Later infections usually respond to simple incision and drainage. Antibiotics are required only if there is extensive cellulitis, bacteremia, or failure to defervesce within 12 to 24 hours of opening the wound (71). Debridement under anesthesia is sometimes required (70). Fascial dehiscence of the wound occurs in 0.5% of post-cesarean patients and may be more common when wound infection is present (64,70). Fascial repair under anesthesia may be necessary. Modern management of open wounds, including secondary closure within 1 to 4 days of disruption, negative pressure wound therapy (vacuum-assisted closure), or healing by secondary intention with dressings that keep the wound moist and absorb drainage, has been shown to be superior to frequently changed, traditional “wet-to-dry” dressings and cleansers that disrupt wound healing (65).
Treatment approaches of stage III and IV pressure injury in people with spinal cord injury: A scoping review
Published in The Journal of Spinal Cord Medicine, 2023
Carina Fähndrich, Armin Gemperli, Michael Baumberger, Marco Bechtiger, Bianca Roth, Dirk J. Schaefer, Reto Wettstein, Anke Scheel-Sailer
All approaches describe a debridement as the baseline of surgical treatment because it is the most efficient method of wound cleaning.3,5–7,9,11,15,31–35 During the surgical debridement, all necrotic tissue and infected bone should be removed.3,5,33,34 The debridement can be carried out with a scalpel, electrocautery, rongeur or curette.3 Moreover, anesthesia is often indicated because of autonomic dysreflexia, pain and/or bleeding.3 Ljung et al. and Rieger et al. perform the debridement with pseudotumor technique.6 In this procedure, the wound margin is incised at a sufficient distance in healthy tissue, the ulcer margins are sutured together with retaining sutures and the ulcer is excised, taking any necrosis and surrounding scar tissue with it.5 Furthermore, Tadiparthi et al. mention to use methylene blue in order to trace the extent of any sinus tract formation.7 Ljung et al. remove the underlying bone and make it smooth and less prominent.6 Debridement and surgical closure in the same procedure was described by Ljung et al. and Tadiparthi et al.6,7 In contrast, Jordan et al., Kreutzträger et al., Sørensen et al. and the Consortium for Spinal Cord Medicine prefer serial debridement, especially in cases of heavy bioburden.3,9,15,31
A Rare Fungal Orbital Infection in an Immunocompetent Young Male Caused by Lichtheimia corymbifera (Absidia corymbifera)
Published in Ocular Immunology and Inflammation, 2022
Vazhipokkil Anju Chandran, Kirthi Koka, Lily Therese, Bipasha Mukherjee
Wide and radical excision of the necrotic orbital tissue lowers the fungal load. It is usually recommended to continue debridement until one encounters bleeding, which indicates healthy tissue.2,5 Antifungals are more effective when necrotic tissue is removed, enabling better access of the drug to the surrounding tissues. Painful blind eye and extensive orbital disease are indications for exenteration, as in our patient who did not respond to systemic therapy.2 Intraorbital irrigation with amphotericin B may be effective for local control of the disease.2 The dosage ranges from 0.25 to 1.25 mg/dl given in a volume of 1–15 ml daily or four times daily over days to weeks.10 Oral posaconazole administered in the dosage of 200 mg every 6 hours is preferred in patients with renal impairment. Unlike Amphotericin B, posaconazole can be given as a maintenance drug for longer durations with its lesser side effects profile.11
Reconstruction of full width, full thickness cicatricial eyelid defect after eyelid blastomycosis using a modified tarsoconjunctival flap advancement
Published in Orbit, 2022
Aaron R. Kaufman, Chau Pham, Peter W. MacIntosh
Blastomyces dermatidis is a dimorphic fungus endemic in the Mississippi River and Ohio River valleys and along the border between US and Canada. Blastomycosis most commonly affects the skin, bone, genitourinary system, and central nervous system.1 The cutaneous lesions may have a verrucous appearance with raised borders and a characteristic “black dot sign,” representing degenerated papillary blood vessels that extravasate red blood cells between the dermis and epidermis.2 Eyelid involvement has been reported to occur in 1–25% of blastomycosis cases.3,4 Eyelid-involving blastomycosis may be treated with systemic antifungal agents such as itraconazole3,5–7 or other azoles in immunocompetent patients without severe systemic disease, and the total duration of antifungal therapy may range from two months6 up to a year.5 Surgical debridement of active infection is not generally needed.7