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1.
BMC Musculoskelet Disord ; 22(1): 917, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34724946

RESUMO

OBJECTIVE: To investigate the clinical efficacy and feasibility of posterior-only debridement, internal fixation, and interbody fusion using titanium mesh in the surgical treatment of thoracolumbar tuberculosis (TB) with spinal epidural abscess. METHODS: From January 2008 to January 2014, a total of 45 patients (27 male and 18 female) were reviewed. The patients were diagnosed with thoracolumbar TB with spinal epidural abscess. The patients underwent posterior-only debridement, internal fixation, and interbody fusion using titanium mesh. Hence, we assessed the intraoperative and postoperative complications, disease recurrences, kyphosis deformity correction, and neurological improvement following the American Spinal Injury Association (ASIA). We used SPSS 22.0 for the statistical analyses. An independent Student's t-test was used for the analysis of preoperative and postoperative continuous variables. The value of P (P < 0.05) was considered statistically significant. RESULTS: The mean age of patients was 37.76 ± 10.94 years (17-59 years). The mean follow-up time was 82.76 ± 12.56 months (60-128 months). The mean kyphosis Cobb angle preoperative was 29.36 ± 13.29° (5-55°) and postoperative was 3.58 ± 5.44° (- 6-13°), given the value of P (P < 0.001). According to the neurological score by the ASIA scale, there were 3 cases of grade B, 11 cases of grade C, 16 cases of grade D, and 15 cases of grade E preoperatively. The neurological score improved by 1 ~ 2 grades. All patients achieved pain relief and the VAS score significantly reduced at the last follow-up (P<0.05). While 1 patient had cerebrospinal fluid leakage, 1 had a neurological complication, 1 had delayed surgical wound healing, and 1 had a disease recurrence. No pseudoarthrosis or implant failure occurred in our patients. All patients achieved solid bone graft fusion. CONCLUSION: For thoracolumbar TB patients with spinal epidural abscess, posterior-only debridement, internal fixation, and interbody fusion using titanium mesh are safe and effective surgical treatments.


Assuntos
Abscesso Epidural , Fusão Vertebral , Tuberculose da Coluna Vertebral , Adulto , Desbridamento , Feminino , Seguimentos , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Telas Cirúrgicas , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Titânio , Resultado do Tratamento , Tuberculose da Coluna Vertebral/diagnóstico por imagem , Tuberculose da Coluna Vertebral/cirurgia
2.
Wounds ; 33(9): 226-230, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34734841

RESUMO

INTRODUCTION: Necrotizing fasciitis results in progressive destruction of the fascia and overlying tissue. Mortality primarily depends upon the timing of medical care and the extent of infection. OBJECTIVE: This article presents a case series of thigh abscesses originating from intra-abdominal pathologic conditions and progressing to necrotizing fasciitis due to delayed diagnosis. MATERIALS AND METHODS: The data concerning 3 patients with thigh abscess originating from an intra-abdominal pathologic condition and progressing to necrotizing fasciitis are presented. RESULTS: All patients had undergone previous colorectal surgery for malignancy and were admitted to the hospital with pain concentrated in the lower back and spreading down to the buttock, sacrum and coccyx, and leg. Patients had received symptomatic therapy, including nonsteroidal anti-inflammatory drugs, and 1 patient had undergone diskectomy for a herniated disk in the lumbar region. All 3 patients subsequently developed thigh abscesses (initially treated by percutaneous and/or surgical drainage) and received antibiotic therapy. One patient underwent percutaneous drainage, and 2 patients underwent abdominal surgery to address the abdominal abscess. During the course of treatment, thigh abscesses progressed to necrotizing fasciitis, which was treated by surgical debridement with or without negative pressure wound therapy. All patients died of overwhelming sepsis. CONCLUSIONS: Thigh abscess may spontaneously arise from surrounding soft tissues, or it may be a sign of intraperitoneal, retroperitoneal, or pelvic pathologic conditions. Deep, vague pain in the back or hip area that spreads downward to the buttock and leg may be an early symptom of these pathologic conditions. Clinical suspicion may be effective in reducing mortality by enabling early surgical intervention, especially in the patient with a previous history of abdominal surgery, radiotherapy, or inflammatory or malignant disease.


Assuntos
Abscesso Abdominal , Fasciite Necrosante , Abscesso/complicações , Abscesso/terapia , Desbridamento , Drenagem , Fasciite Necrosante/complicações , Fasciite Necrosante/terapia , Humanos , Coxa da Perna
3.
J Wound Ostomy Continence Nurs ; 48(6): 568-572, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34781314

RESUMO

BACKGROUND: Tuberculosis (TB) is a leading infectious disease worldwide. It rarely occurs in the scapula and toe joints and is easily misdiagnosed. Without prompt treatment, the associated lesions can spread to surrounding soft tissues such as joint capsules, muscles, tendons, and fascia. In severe cases, the bones and articular surfaces can become significantly damaged; it is not uncommon for deep skeletal TB wounds with sinus tracts to form, which are very difficult to treat. We report our successful wound care management approach for one patient with multiple skeletal TB complicated with multiple deep sinus tracts. CASE: The patient was treated with anti-TB medications, and wound and bone debridement (sharps, surgical) combined with vacuum-shielded drainage (VSD) (Kula, CG Bio Co Ltd, Gyeonggi-do, South Korea) to fill the sinus tract. We removed the caseous (cheese-like) necrotic tissue, purulent drainage, and necrotic tissue at the base of the wound to ensure optimal wound care. Throughout the course of treatment, we selected different types of dressings to maintain moist wound healing and absorb excessive drainage. After 144 days of treatment, the wound and deep sinus tracts completely healed. CONCLUSIONS: Wounds related to skeletal TB with multiple sinus tracts are difficult to manage and heal. We found our wound protocol that included timely debridement and use of VSD was effective for the management of these complex wounds. Specifically, our approach filled the dead space in the sinus tract, removed excessive drainage, promoted the growth of granulation tissue, and overall promoted tissue healing.


Assuntos
Tratamento de Ferimentos com Pressão Negativa , Tuberculose , Desbridamento , Drenagem , Humanos , Transplante de Pele , Resultado do Tratamento , Cicatrização
4.
J Wound Ostomy Continence Nurs ; 48(6): 516-522, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34781306

RESUMO

Debridement is described in the literature as having a high level of clinical risk and may result in patient harm when performed by untrained nurses. As a result, specialized knowledge, skills, and competencies are required to initiate, direct, and perform safe and effective debridement. This executive summary provides an overview of Debridement: Canadian Best Practice Recommendations for Nurses from the Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC). The primary objective of these recommendations is to positively influence patient outcomes and enhance safety. The 12 recommendations place the safety of the patient and nurse at the forefront and highlight the educational, competency, certification, preceptor/mentorship, and legal requirements for nurses to initiate, direct, and perform all methods of debridement. We designed these recommendations to be circulated and implemented widely by nurses of various professional levels across the continuum of care and advocate for organizations and government agencies to clearly define debridement in their policies and legislative regulations.


Assuntos
Enfermeiras e Enfermeiros , Estomia , Canadá , Desbridamento , Humanos
5.
BMC Musculoskelet Disord ; 22(1): 947, 2021 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-34781926

RESUMO

BACKGROUND: The aim of the present study was to investigate the efficacy and safety of mini-open oblique debridement and lumbar interbody fusion combined with lateral screw fixation for treating single-level pyogenic spondylodiscitis. METHODS: Twelve patients with single-level lumbar pyogenic spondylodiscitis underwent OLIF combined with lateral screw fixation were analyzed. Patients underwent follow-up for 12 to 24 months. The clinical characteristics, etiological examinations, operative time, intraoperative blood loss, Oswestry Disability Index (ODI), visual analog scale score (VAS), postoperative complications, and the bony fusion rate were recorded. RESULTS: The mean follow-up period of time was 14.8 months. The average operative time and intra-operative blood loss were 129.0 ± 19.76 min and 309.2 ± 92.96 mL, respectively. No severe intra-operative complications were observed during surgery, except in 1 case that develops abdominal pain and distension after surgery, 2 cases that develop left-sided transient thigh pain/numbness and 8 cases that complains of donor site (iliac crest) pain. All of these symptoms disappeared 8 weeks after surgery. Tissue sample cultures were obtained from all patients intraoperatively and four (33.3%) were positive, including 2 with Staphylococcus aureus, 1 with Staphylococcus epidermidis, and 1 with Escherichia coli. During an average of 22.5 ± 2.1 days (range, 14-29 days) after surgery, WBC, CPR, and ESR levels in all patients had returned to normal. All patients were pain free with no recurring infection. Solid bony fusions were observed in all cases within 6 months, including 10 with I grade fusion, 2 with II grade fusion according to the classification suggested by Burkus et al. No fixation failure was observed during follow up and solid bony fusions were observed in all 12 patients at finally follow-up. A significant postoperative increase was also observed in the mean segmental height and lordosis (P < 0.05), followed by a slight decrease of segmental height and lordosis at final follow-up. At the final follow up, the mean VAS (1.5 ± 0.6) and ODI (18.9 ± 7.6) were significantly lower than VAS (8.4 ± 2.7) and ODI (71.2 ± 16.5) before surgery (P < 0.01). CONCLUSION: Single-stage debridement with autogenous iliac bone graft through the OLIF corridor and lateral fixation was a feasible surgical approach in our consecutive 12 cases of pyogenic spondylitis.


Assuntos
Discite , Fusão Vertebral , Desbridamento , Discite/diagnóstico por imagem , Discite/cirurgia , Humanos , Ílio/diagnóstico por imagem , Ílio/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Resultado do Tratamento
6.
J Pak Med Assoc ; 71(11): 2665-2668, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34783757

RESUMO

Carbuncle is a painful subcutaneous mass of interconnected infected hair follicles with multiple discharging sinuses. It has predisposition in conditions like diabetes, immune-compromised states, chronic skin diseases etc. The authors present a case of a 67 year old diabetic male admitted in July 2020 at Akbar Niazi Teaching Hospital (ANTH) Islamabad, with a giant carbuncle on his back. Due to its large size, systemic co-morbidity, and increased risk of complications in surgical treatment, a multi-disciplinary team approach was employed. Both general and plastic surgeons were involved, who performed excision and soft tissue coverage respectively. The aim of the surgical intervention methods, like wide excision and debridement, application of vacuum assisted wound closure (VAC), and skin grafting was to minimise the healing time and risk of development of post-operative infection. The patient was surgically managed and sent home in a good condition.


Assuntos
Carbúnculo , Idoso , Desbridamento , Humanos , Masculino , Pele , Transplante de Pele , Cicatrização
7.
Wounds ; 33(10): 263-270, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34735364

RESUMO

INTRODUCTION: Chitosan has been proven to be helpful in wound care as a hemostatic agent. The hemostatic effect is due to the positively charged chitosan interacting with negatively charged red blood cell membranes, initiating the agglutination of red blood cells and platelets. This promotes the activation of thrombin, which activates the clotting pathway, leading to thrombus formation. OBJECTIVE: Based on the properties of chitosan as a rapidly acting hemostatic agent, the authors sought to determine if a chitosan gelling fiber wound dressing could control bleeding of freshly debrided wounds. The effect of the chitosan dressing on overall healing and patient and provider satisfaction was also evaluated. MATERIALS AND METHODS: Wounds of any etiology requiring sharp debridement in patients older than 18 years who were capable of consent were eligible. Wounds were sharply debrided by curettage, scalpel, electrosurgery, or a combination of methods. A chitosan dressing was applied to the freshly debrided wound with gentle pressure. The time from application to hemostasis as assessed by non-progression of blood pattern was measured. Other outcome measures also included digital photography, wound surface area, numerical pain scores, and Photographic Wound Assessment Tool (PWAT) scores. Patient and provider satisfaction were measured. RESULTS: Twenty patients with a variety of etiologies and ulcer types were evaluated. After debridement, wound bleeding was rated as mild (n=9), moderate (n=9), or severe (n=2). The mean time to hemostasis was 75 seconds ± 41 SD (range, 28-221 seconds). In 1 week, the mean wound area decreased from 6.9 cm2 ± 7.8 to 6.2 cm2 ± 7.9 and mean PWAT scores decreased from 17.7 ± 4.9 to 11.4 ± 5.0 (lower score indicates wound healing). Pain scores associated with wound debridement were reduced in all but 1 patient evaluated at week 1. Overall, the rating scores from the Patient Reported Acceptance Questionnaire (PRAQ) and Provider Acceptance Questionnaire (PAQ) developed by this research group were high. The mean total PRAQ score was 30.5 ± 3.9 out of 35 (35 being most satisfied). The PAQ score was 15 out of 15 for all but 1 patient (15 being most satisfied). CONCLUSIONS: The chitosan gelling fiber wound dressing was simple to use and rapidly promoted hemostasis in fresh sharply debrided wounds. It was safe and easy to use in an outpatient setting and was highly rated by the patients.


Assuntos
Quitosana , Hemostáticos , Quitosana/farmacologia , Quitosana/uso terapêutico , Desbridamento , Hemostasia , Hemostáticos/farmacologia , Hemostáticos/uso terapêutico , Humanos , Úlcera , Cicatrização
8.
Acta Med Indones ; 53(3): 349-351, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34611076

RESUMO

COVID-19 is a disease reported to suppress cellular immunity. This may lead to the development of opportunistic infections, among others black fungus, or mucormycosis. On the other hand, pre-existing defect in immunity may render patients susceptible to both mucormycosis and COVID-19. Mucormycosis is a relatively rare fungal infection with rapid progression unless diagnosed promptly and treated adequately, and urgent surgical and medical intervention is lifesaving. The manifestation of mucormycosis largely depends on the presence of exposure to the pathogen and the existing risk factor of the host. As black fungus is locally invasive, the majority of cases will involve tissue damage with local destruction and contiguous spread to nearby structure. We here with present a case of black fungus complicated with COVID-19 in a man with underlying non-Hodgkin's lymphoma.


Assuntos
COVID-19 , Linfoma não Hodgkin , Mucorales/isolamento & purificação , Mucormicose , Septo Nasal/patologia , SARS-CoV-2/isolamento & purificação , Adulto , Biópsia/métodos , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/fisiopatologia , COVID-19/terapia , Desbridamento/métodos , Progressão da Doença , Humanos , Linfoma não Hodgkin/complicações , Linfoma não Hodgkin/patologia , Linfoma não Hodgkin/fisiopatologia , Masculino , Mucormicose/complicações , Mucormicose/microbiologia , Mucormicose/patologia , Mucormicose/fisiopatologia , Doenças Nasais/microbiologia , Doenças Nasais/patologia , Isolamento de Pacientes/métodos , Tempo para o Tratamento , Tomografia Computadorizada por Raios X/métodos
9.
Medicine (Baltimore) ; 100(37): e27198, 2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34664848

RESUMO

ABSTRACT: To describe the retroperitoneoscopic debridement technique and evaluate the clinical outcome of internal fixation for the treatment of lumbar tuberculosis.Twenty-eight patients were performed conventional laparoendoscopic technique (n = 17) or laparoendoscopic single-site technique (n = 11). Antituberculosis chemotherapy and thoracolumbosacral orthosis were given to all patients. The clinical outcomes were evaluated with preoperative and postoperative Visual Analog Scale, and radiographs with respect to sagittal angle and fusion status.Average time of the 28 procedures was 220.6 ±â€Š50.9 min (180-365 min). The average intraoperative blood loss was 108.6 ±â€Š95.3 mL (50-400 mL). All patients showed significant improvement of their Visual Analog Scale back pain score at follow-up and were classified as having a radiographic fusion in this study. The mean sagittal angle was 11.2 ±â€Š3.6° before operation, significantly improved to 3.7 ±â€Š2.4° after operation. There were no recurrent infections during the follow-up period. Complications included loosening of anterior fixation and temporary deficit of the sympathetic nerve.Retroperitoneal laparoscopic approach with CO2 insufflation technique is a challenging but safe and effective procedure for lumbar spine tuberculosis. Retroperitoneal laparoendoscopic single-site can be used for anterior lumbar spine surgery, offer exposure for L1 through L5.


Assuntos
Desbridamento/normas , Fixadores Internos/normas , Tuberculose Osteoarticular/cirurgia , Adulto , Idoso , Desbridamento/métodos , Desbridamento/estatística & dados numéricos , Feminino , Humanos , Fixadores Internos/estatística & dados numéricos , Região Lombossacral/anormalidades , Região Lombossacral/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Espaço Retroperitoneal/anormalidades , Espaço Retroperitoneal/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento
10.
J Int Med Res ; 49(10): 3000605211050781, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34666530

RESUMO

OBJECTIVE: Kashin-Beck disease (KBD) is an endemic degenerative joint disease with a high disability rate. We retrospectively evaluated the 18-year clinical follow-up outcomes of adult patients with KBD who underwent arthroscopic debridement for knee osteoarthritis. METHODS: Thirty-one patients with KBD (31 knees) underwent arthroscopy for knee osteoarthritis. The visual analog scale (VAS) score, walking distance, knee mobility, and patients' self-evaluated improvement in clinical symptoms were retrospectively evaluated before and 18 years after the operation. RESULTS: The patients' self-evaluated clinical symptoms showed considerable improvement at 2, 6, and 8 years after surgery but deteriorated at 10 and 18 years after surgery. Knee mobility was greater after than before arthroscopy but decreased from 6 to 18 years postoperatively. The VAS score for knee pain was high before the operation, decreased at 2 years postoperatively, increased at 6 years postoperatively, and was significantly lower at 18 years postoperatively than before surgery. The walking distance was significantly longer at 2, 6, and 8 years postoperatively than preoperatively. CONCLUSIONS: Arthroscopic treatment may be an effective therapy for adult patients with KBD who develop knee osteoarthritis. In this study, arthroscopy had a long-term effect on patients with KBD who had Kellgren-Lawrence grade

Assuntos
Doença de Kashin-Bek , Osteoartrite do Joelho , Adulto , Artroscopia , Desbridamento , Seguimentos , Humanos , Doença de Kashin-Bek/cirurgia , Osteoartrite do Joelho/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
11.
J Cardiothorac Surg ; 16(1): 292, 2021 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-34629078

RESUMO

BACKGROUND: Deep sternal wound infection (DSWI) is a rare but serious complication after median sternotomy, and treatment success depends mainly on surgical experience. Here we first present a case of a patient successfully treated for antibiotic-loaded bone cement (ALBC) combined with vacuum sealing drainage (VSD) of DSWI. CASE PRESENTATION: This case report presented a patient who underwent open heart surgery, and suffered postoperatively from a DSWI associated with enterococcus cloacae. Focus debridement combined with ALBC filling and VSD was conducted in stage I. Appropriate antibiotics were started according to sensitivity to be continued for 2 weeks until the inflammatory markers decreased to normal. One month after the surgery, patient's wound was almost healed and was discharged from hospital with a drainage tube. Two months after the stage I surgery procedure, the major step was removing the previous ALBC, and extensive debridement in stage II. The patient fully recovered without further surgical treatment. CONCLUSIONS: The results of this case suggest that ALBC combined with VSD may be a viable and safe option for deep sternal wound reconstruction.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Tratamento de Ferimentos com Pressão Negativa , Antibacterianos/uso terapêutico , Cimentos Ósseos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Desbridamento , Drenagem , Humanos , Retalhos Cirúrgicos , Infecção da Ferida Cirúrgica/terapia , Resultado do Tratamento , Cicatrização
12.
Adv Skin Wound Care ; 34(11): 603-607, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34669663

RESUMO

OBJECTIVE: To critically analyze the existing randomized controlled trials (RCTs) on the clinical, economic, and psychological implications of maggot debridement therapy (MDT). DATA SOURCES: An exhaustive literature search for English-language publications was conducted using MEDLINE, EMBASE, and PubMed. STUDY SELECTION: Keywords used for the search were based on the PICO (Population, Intervention, Comparison, Outcome) framework. The titles, abstracts, and relevant full-text articles were screened. Seven RCTs were selected after applying the inclusion and exclusion criteria. DATA EXTRACTION: Data pertaining to the primary and secondary outcomes of each study were extracted. DATA SYNTHESIS: The data extracted were evaluated and categorized into clinical, economic, and psychological outcomes pertaining to MDT. A judicious evaluation of these outcomes was made, and the following conclusions were drawn. CONCLUSIONS: There exists heterogeneity in the extant RCTs, but MDT appears to be effective for a quick early debridement. For diabetic foot ulcers, MDT improves debridement, controls infection, and enhances wound healing. In chronic peripheral vascular disease ulcers, it aids in early debridement, but the final outcome is equivocal. Further robust integrated health economic and parallel qualitative assessment studies are recommended to understand the cost-effectiveness and patient acceptability and experience.


Assuntos
Desbridamento/métodos , Larva , Úlcera da Perna/terapia , Animais , Desbridamento/estatística & dados numéricos , Humanos , Úlcera da Perna/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos
13.
Medicine (Baltimore) ; 100(42): e27577, 2021 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-34678903

RESUMO

RATIONALE: Currently, there is no consensus regarding the best treatment for patients with thromboangiitis obliterans (TAO). Regenerative medicine, such as bone marrow stem cells or adipose-derived stem cell (ASC) transplantation, have proven efficacy in improving tissue perfusion and wound healing in clinical trials. In this case, we used nanofat grafting to treat severe conditions in a patient with TAO, with promising outcomes. PATIENT CONCERNS: This is a case of a 48-year-old smoker who presented with cyanosis in both hands and the right foot, with gangrenous changes. Investigative angiography showed severe vasospasm in the radial and ulnar arteries of the patient's left hand. Progressive cyanosis of the patient's left hand was noted which may eventually require amputation if left untreated. DIAGNOSES: He was diagnosed with TAO under the Shionoya diagnostic criteria. INTERVENTIONS: Fasciotomy and necrotic tissue debridement were performed, followed by centrifuged nanofat grafting. The nanofat graft was prepared using Pallua method and deployed with a MAFT-GUN (Dermato Plastica Beauty Co., Ltd., Kaohsiung, Taiwan). OUTCOMES: Three months later, computed tomography angiography revealed a radial artery patency. The patient's wrist function was preserved with uneventful wound healing. LESSONS: The regenerative ability of centrifuged nanofat grafts not only helps wound healing but also helps reverse vasospasm and preserve remnant tissue perfusion.


Assuntos
Tecido Adiposo/transplante , Mãos/patologia , Mãos/cirurgia , Isquemia/etiologia , Isquemia/cirurgia , Tromboangiite Obliterante/complicações , Desbridamento , Humanos , Masculino , Pessoa de Meia-Idade
14.
Am Fam Physician ; 104(4): 386-394, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34652105

RESUMO

Diabetes-related foot infections occur in approximately 40% of diabetes-related foot ulcers and cause significant morbidity. Clinicians should consider patient risk factors (e.g., presence of foot ulcers greater than 2 cm, uncontrolled diabetes mellitus, poor vascular perfusion, comorbid illness) when evaluating for a foot infection or osteomyelitis. Indicators of infection include erythema, induration, tenderness, warmth, and drainage. Superficial wound cultures should be avoided because of the high rate of contaminants. Deep cultures obtained through aseptic procedures (e.g., incision and drainage, debridement, bone culture) help guide treatment. Plain radiography is used for initial imaging if osteomyelitis is suspected; however, magnetic resonance imaging or computed tomography may help if radiography is inconclusive, the extent of infection is unknown, or if the infection orientation needs to be determined to help in surgical planning. Staphylococcus aureus and Streptococcus agalactiae are the most commonly isolated pathogens, although polymicrobial infections are common. Antibiotic therapy should cover commonly isolated organisms and reflect local resistance patterns, patient preference, and the severity of the foot infection. Mild and some moderate infections may be treated with oral antibiotics. Severe infections require intravenous antibiotics. Treatment duration is typically one to two weeks and is longer for slowly resolving infections or osteomyelitis. Severe or persistent infections may require surgery and specialized team-based wound care. Although widely recommended, there is little evidence on the effectiveness of primary prevention strategies. Systematic assessment, counseling, and comorbidity management are hallmarks of effective secondary prevention for diabetes-related foot infections.


Assuntos
Antibacterianos/administração & dosagem , Pé Diabético/terapia , Antibacterianos/efeitos adversos , Bandagens , Desbridamento , Pé Diabético/diagnóstico , Pé Diabético/microbiologia , Pé Diabético/prevenção & controle , Humanos , Fatores de Risco , Índice de Gravidade de Doença , Sapatos
15.
Am Fam Physician ; 104(4): 395-402, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34652112

RESUMO

Osteomyelitis is an inflammatory condition of bone secondary to an infectious process. Osteomyelitis is usually clinically diagnosed with support from imaging and laboratory findings. Bone biopsy and microbial cultures offer definitive diagnosis. Plain film radiography should be performed as initial imaging, but sensitivity is low in the early stages of disease. Magnetic resonance imaging with and without contrast media has a higher sensitivity for identifying areas of bone necrosis in later stages. Staging based on major and minor risk factors can help stratify patients for surgical treatment. Antibiotics are the primary treatment option and should be tailored based on culture results and individual patient factors. Surgical bony debridement is often needed, and further surgical intervention may be warranted in high-risk patients or those with extensive disease. Diabetes mellitus and cardiovascular disease increase the overall risk of acute and chronic osteomyelitis.


Assuntos
Antibacterianos/uso terapêutico , Desbridamento , Osteomielite/terapia , Humanos , Imageamento por Ressonância Magnética , Osteomielite/diagnóstico por imagem , Radiografia , Fatores de Risco , Índice de Gravidade de Doença
16.
BMC Musculoskelet Disord ; 22(1): 895, 2021 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-34674675

RESUMO

BACKGROUND: The relevance between the presence of a sinus tract and the failure risk after debridement, antibiotics and implant retention (DAIR) for periprosthetic joint infection (PJI) after hip or knee arthroplasty is still unclear. This study aimed to compare the success rate of DAIR between patients with or without a sinus tract and to explore the possible risk factors for failure after DAIR in patients with a sinus tract. METHODS: Consecutive DAIR cases for PJI after hip or knee arthroplasty between January 2009 and June 2019 with a minimum 1-year follow-up in two tertiary joint arthroplasty centers were included. Patients were classified into the sinus tract group and the non-sinus tract group according to the presence of a sinus tract. The success rate after DAIR were compared using Kaplan-Meier survival analysis. Potential risk factors for failure in the sinus group were also explored. RESULTS: One hundred seven patients were included. At a median 4.4 years of follow-up, 19 of 52 (36.5%) cases failed in the sinus tract group, while 15 of 55 (27.3%) cases failed in the non-sinus tract group. The 1-year and 5-year cumulative success rates were 71.2% (95% confidence interval (CI): 59.8-84.6%) and 56.8% (95% CI: 42.6-75.7%) in the sinus tract group, respectively, which were similar to the counterparts in the non-sinus tract group (P = 0.214). Among patients with a sinus tract, DAIR with the exchange of modular components showed a higher success rate (75.8% versus 47.4%, P = 0.038). CONCLUSIONS: The presence of a sinus tract does not affect the success rate of DAIR. Modular component exchange in DAIR was proposed for patients with a sinus tract for an improved infection control rate.


Assuntos
Prótese de Quadril , Prótese do Joelho , Infecções Relacionadas à Prótese , Antibacterianos/uso terapêutico , Desbridamento , Prótese de Quadril/efeitos adversos , Humanos , Prótese do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
18.
J Wound Care ; 30(Sup9a): VIIi-VIIxi, 2021 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-34570633

RESUMO

BACKGROUND: Maggot debridement therapy (MDT), or the use of maggots in dead tissue removal, has been shown to be beneficial in wound healing. Yet MDT in the US is often only used once conventional debridement methods have failed. METHOD: In this study, nine health professionals, experienced in MDT, were interviewed in order to identify and analyse the perceived societal barriers to MDT acceptance and usage in the US. RESULTS: Through qualitative analysis, using the grounded theory framework, this study found that among those interviewed, insurance reimbursement restrictions and stigmatisation of medicinal maggots were the factors driving resistance to MDT use. CONCLUSION: Specifically, the 'yuck' factor and the perception of MDT as an 'ancient' modality contributed towards MDT stigma; in addition, lack of outpatient insurance coverage deterred MDT use. These findings provide useful information regarding the perceptual and systemic barriers that prevent greater acceptance of MDT. Ultimately, these barriers must be understood if we are to facilitate MDT implementation and improve MDT usage in the future.


Assuntos
Procedimentos Cirúrgicos Dermatológicos , Cicatrização , Animais , Desbridamento , Humanos , Larva , Percepção
19.
BMJ Case Rep ; 14(9)2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34531233

RESUMO

Mucormycosis is a very commonly encountered disease in the sinonasal region in patients with diabetes and immunocompromised status specially in the northern part of the Indian continent. Due to its fulminant nature and involvement in the rhino-orbital-cerebral region, prognosis is poor even after extensive debridement and amphotericin-B therapy. We present a case with diagnosis of sarcoidosis being treated with systemic steroids who developed sudden-onset ptosis and left lateral rectus palsy. On radiological evaluation with MRI, a heterogenously peripherally enhancing lesion was seen in the nasopharynx suggestive of nasopharyngeal abscess. The patient was taken up for emergency surgery; a necrotic lesion with destruction of sphenoid bone, pterygoids and clivus was seen originating in the nasopharynx. The lesion on fungal staining came out to be broad aseptate hyphae suggestive of mucormycosis.


Assuntos
Mucorales , Mucormicose , Osteomielite , Antifúngicos/uso terapêutico , Desbridamento , Humanos , Mucormicose/diagnóstico , Mucormicose/tratamento farmacológico , Osteomielite/diagnóstico por imagem , Osteomielite/tratamento farmacológico , Base do Crânio/diagnóstico por imagem
20.
Khirurgiia (Mosk) ; (9): 85-92, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34480460

RESUMO

The review is devoted to endoscopic transluminal interventions in the treatment of acute necrotizing pancreatitis. Terminology, indications and options for transluminal drainage procedures and endoscopic sequestrectomy are presented in detail. The authors analyzed the results of numerous studies devoted to effectiveness of endoscopic interventions and possible combination of treatment options. Modern international clinical guidelines indicating the feasibility of endoscopic treatment of acute necrotizing pancreatitis in multi-field specialized centers are considered.


Assuntos
Pancreatite Necrosante Aguda , Desbridamento , Drenagem , Endoscopia , Humanos , Pancreatite Necrosante Aguda/diagnóstico , Pancreatite Necrosante Aguda/cirurgia , Resultado do Tratamento
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