Assessment of arthroscopic shavers: a comparison test of resection performance and quality.

BACKGROUND: Arthroscopic shavers play an indispensable role in arthroscopic debridement. They have exquisite structures and similar designs. The purpose of this study was to establish a reproducible testing protocol to compare the resection performance and the quality (tensile strength, torsional strength, and corrosion resistance) of different arthroscopic shavers with comparable designs. We hypothesized that there could be little difference in resection performance and quality between these shavers. METHODS: Incisor Plus Blade (IPB; Smith & Nephew, Andover, MA) and Double Serrated Plus Blade (DSPB; BJKMC, Shanghai, China) were selected for resection performance and quality test. For resection performance testing, the resection torque, which is the minimum torque required to cut off silicone blocks with the same cross-sectional area, was measured to evaluate the resection performance of shaver blades when the other factors remain the same. For quality testing, tensile and torsion tests of the shavers' joint part were performed, and ultimate failure load and maximum torque were measured and compared. The corrosion resistance of these blades was assessed by the boiling water test based on the ISO13402. RESULTS: No significant difference existed in the resection torque between the shaver blades of IPB and DSPB (P = 0.54). To the failure load of shavers' joint parts, IPB was significantly higher than DSPB, both in the outer and inner blades (P < 0.0001). The maximum torque of the joint part had no significant difference between IPB and DSPB (for inner blades P = 0.60 and outer blades P = 0.94). The failure load (for both IPB and DSPB P < 0.0001) and maximum torque (for IPB P = 0.0475 and DSPB P = 0.015) of the inner blades were higher than those of the outer blades. No blemishes were observed on the surface of the blades after corrosion resistance tests. CONCLUSIONS: This study provided some new methods to evaluate the resection performance and quality of different shavers. The resection performance, the torsional strength of the joint part, and the corrosion resistance of IPB and DSPB may show comparable properties, whereas the tensile strength of the shavers' joint part showed some level of difference.

An in vitro assessment of bacterial transfer by products used in debridement.

OBJECTIVE: The aim of this in vitro study was to investigate the transfer of viable Pseudomonas aeruginosa biofilm microorganisms following treatment with debridement tools. METHOD: The level of viable biofilm microorganisms transferred by debridement tools was compared following treatment that reflected the clinical practice of each product. RESULTS: A significant level of microorganism transfer was seen in response to the mechanical debridement tool. Minimal transfer of microorganisms was seen when in vitro-established biofilms were treated with hydroresponsive wound dressing + polyhexamethylene biguanide (HRWD+PHMB, HydroClean plus). Less Pseudomonas aeruginosa was recovered from explants exposed to dressings compared with those exposed to debridement tools suggesting that there was less transfer of bacteria by dressings. CONCLUSION: The reduced transfer of viable microorganisms by HRWD+PHMB may be the result of significant binding and retention of microbes by the superabsorbent polymer within the dressing, together with enhanced sequestered bacterial killing within the dressing by polymer-bound PHMB. The high levels of microbial transfer/transmission seen for debridement tools suggests that, in the clinical setting, a significant level of bacterial spread over the wound surface and/or surrounding skin by these cleansing tools is likely.

[Assessment of Technology and Clinical Application of Hydrosurgery System].

This paper introduces the technical features of hydrosurgery system and evaluates it from three aspects:safety and effectiveness, economy and technology maturity. The evaluation results show that the safety and effectiveness are high, and the safety mainly involves the misuse of the system, which cause the adverse events. A large number of literatures have proved that the system is more suitable for the debridement of fine parts. It is estimated that hydrosurgery system has better economic performance, but the cost and patients' cost is also increased correspondingly. In the aspect of technology maturity assessment, this technology is a patented technology, and the number of published papers both at home and abroad is on the rise, indicating that the initial application of the technology is better and the technology is in infancy stage. Therefore, hydrosurgery system has certain advantages in all aspects. Hospitals need to allocate the equipment according to their own needs and clinical application, while a wider range of clinical trials is needed to provide evidence-based evidence for clinical applications and promotion.

Economic Spillovers From Public Investments in Medical Countermeasures: A Case Study of a Burn Debridement Product.

OBJECTIVE: The US federal government invests in the development of medical countermeasures for addressing adverse health effects to the civilian population from chemical, biological, and radiological or nuclear threats. We model the potential economic spillover effects in day-to-day burn care for a federal investment in a burn debridement product for responding to an improvised nuclear device. METHODS: We identify and assess 4 primary components for projecting the potential economic spillover benefits of a burn debridement product: (1) market size, (2) clinical effectiveness and cost-effectiveness, (3) product cost, and (4) market adoption rates. Primary data sources were the American Burn Association's 2015 National Burn Repository Annual Report of Data and published clinical studies used to gain European approval for the burn debridement product. RESULTS: The study results showed that if approved for use in the United States, the burn debridement product has potential economic spillover benefits exceeding the federal government's initial investment of $24 million a few years after introduction into the burn care market. CONCLUSIONS: Economic spillover analyses can help to inform the prioritizing of scarce resources for research and development of medical countermeasures by the federal government. Future federal medical countermeasure research and development investments could incorporate economic spillover analysis to assess investment options. (Disaster Med Public Health Preparedness. 2017;11:711-719).

Emerging Roles of Coblation in Rhinology and Skull Base Surgery.

Coblation is a technology that incorporates bipolar radiofrequency energy to ablate tissue at relatively low temperatures. Its use for sinonasal surgery is actively being investigated, including applications for turbinate reduction, sinus surgery, skull base surgery, and adenoidectomy. Potential benefits include reduction in blood loss, improved endoscopic surgical visualization, and reduction in postoperative pain. The main drawbacks are its relatively high cost, potential adverse effects on functional epithelium, and relative paucity of long-term outcomes.

The Debrisoft(®) Monofilament Debridement Pad for Use in Acute or Chronic Wounds: A NICE Medical Technology Guidance.

As part of its Medical Technology Evaluation Programme, the National Institute for Health and Care Excellence (NICE) invited a manufacturer to provide clinical and economic evidence for the evaluation of the Debrisoft(®) monofilament debridement pad for use in acute or chronic wounds. The University of Birmingham and Brunel University, acting as a consortium, was commissioned to act as an External Assessment Centre (EAC) for NICE, independently appraising the submission. This article is an overview of the original evidence submitted, the EAC's findings and the final NICE guidance issued. The sponsor submitted a simple cost analysis to estimate the costs of using Debrisoft(®) to debride wounds compared with saline and gauze, hydrogel and larvae. Separate analyses were conducted for applications in home and applications in a clinic setting. The analysis took an UK National Health Service (NHS) perspective. It incorporated the costs of the technologies and supplementary technologies (such as dressings) and the costs of their application by a district nurse. The sponsor concluded that Debrisoft(®) was cost saving relative to the comparators. The EAC made amendments to the sponsor analysis to correct for errors and to reflect alternative assumptions. Debrisoft(®) remained cost saving in most analyses and savings ranged from £77 to £222 per patient compared with hydrogel, from £97 to £347 compared with saline and gauze, and from £180 to £484 compared with larvae depending on the assumptions included in the analysis and whether debridement took place in a home or clinic setting. All analyses were severely limited by the available data on effectiveness, in particular a lack of comparative studies and that the effectiveness data for the comparators came from studies reporting different clinical endpoints compared with Debrisoft(®). The Medical Technologies Advisory Committee made a positive recommendation for adoption of Debrisoft(®) and this has been published as a NICE medical technology guidance (MTG17).

[Gold standard for implant selection in operative therapy of spondylitis/spondylodiscitis]. / Goldstandard bei der Implantatwahl zur operativen Therapie der Spondylitis/Spondylodiszitis.

The operative therapy management of vertebral osteomyelitis including debridement and stabilization is well established. Autologous bone is the preferred graft material but is limited due to availability, failure of consolidation in large defects and donor morbidity. Titanium mesh cages are alternatively equally well evaluated and other materials are also mentioned. Immobilization of affected segments is the fundamental requirement for healing of osteomyelitis. The operative therapy of choice is meticulous debridement and internal stabilization of the defect. Autologous bone seems to provide the best conditions to bridge and consolidate defects. Bone marrow aspirate, reaming irrigator aspiration (RIA) and bone marrow protein (BMP) in combination with cages have the same qualities considering bone healing but they are not yet sufficiently evaluated for management of vertebral osteomyelitis. Autologous bone graft remains the gold standard, nevertheless, its disadvantages point out the need for alternative grafts. Titanium is well proven to provide stability but bone substitutes are not sufficiently evaluated but seem to be promising.

Technological innovations in tissue removal during rhinologic surgery.

BACKGROUND: The modern rhinologist has a wide variety of technological innovations at his/her disposal for the removal of soft tissue and bone during endoscopic surgery. We identified and critically evaluated four leading tissue removal technologies that have impacted, or are poised to impact, rhinological surgery. METHODS: A literature review was conducted. RESULTS: Technological functions, strengths and limitations of microdebriders, radio frequency ablation, endoscopic drills, and ultrasonic aspirators were explored. The primary drawback of powered instruments continues to be the higher costs associated with their use, and their main advantage is the ability to accomplish multiple functions such as tissue removal, suction, and irrigation, all with one tool. The effective and safe use of any powered instrument requires an intimate understanding of its function, capabilities, and limitations. CONCLUSION: Powered instrumentation continues to play a significant and evolving role in soft tissue and bone removal during rhinologic surgery.

Evaluation of the quality and cost-effectiveness of Versajet hydrosurgery.

Judicious resource allocation to maximise benefits is essential to health care decision-making, particularly with increasingly expensive treatments and rising populations. Accurate wound debridement is important, and while many methods exist, surgical debridement is currently the gold standard with material costs at approximately pound 140. Versajet, a hydrosurgical device, is suggested by some to have facilitated a paradigm shift in wound management by allowing debridement of undesirable tissue while accurately preserving viable structures. Its proponents claim that it minimises surgical duration, length of hospital admission, improves wound healing and may be deployed at the bedside or in the community. Consoles and single-use hand-units cost pound 6000- pound 7000 and pound 220- pound 240, respectively. Some propose that hydrosurgery may provide an efficacious, efficient and cost-effective alterative to surgical debridement. However, the evidence available is largely based on expert opinion. Methodological flaws of such descriptive studies include the lack of control groups, selection bias and lack of blinding. Hence, these claims need to be interpreted cautiously. This opinion review examines the available evidence as to whether Versajet hydrosurgery provides quality and cost-effective care.

Ex vivo comparison of mechanical versus thermal chondroplasty: assessment of tissue effect at the surgical endpoint.

PURPOSE: The purpose of this study was to evaluate tissue effect (tissue removal plus underlying cell death) of two chondroplasty techniques: mechanical debridement (MD) using a rotary shaver blade and thermal chondroplasty using radiofrequency energy (RFE). METHODS: Forty-eight human chondromalacic cartilage samples were treated with either MD or RFE. Pre- and post-treatment arthroscopic images of the cartilage surface were recorded. Samples were incubated with cell viability stain and visualized with confocal laser microscopy to determine tissue effect. Smoothing was quantitated by three surgeons using a visual analog scale (VAS) as well as a subjective rating regarding whether smoothing was "arthroscopically acceptable." RESULTS: Tissue effect at the surgical endpoint of arthroscopically acceptable smoothing was 385 microm for MD versus 236 microm for RFE, a significant difference (P < .0001). Mean post-treatment VAS for MD was 2.8 points less smooth than for RFE (P < .0001). Overall, arthroscopically acceptable smoothing was achieved in 90% of RFE samples compared to 49% of MD samples. CONCLUSIONS: Our results shown that chondroplasty using a RFE probe results in greater smoothing of chondromalacic cartilage in fewer treatment passes and with decreased total tissue effect than MD using a rotary shaver blade. CLINICAL RELEVANCE: If safety and efficacy can be shown in vivo, thermal chondroplasty may represent an alternative for treatment of symptomatic chondromalacia.

Efficacy and cost-effectiveness of a high-powered parallel waterjet for wound debridement.

Current concepts of wound healing acknowledge the essential role of wound bed preparation in achieving a wound with good healing potential. Critical to wound bed preparation is the removal of necrosis, unhealthy tissue, foreign matter, and infection. One of the accepted methods of wound bed preparation is surgery. The high-power parallel waterjet is a new surgical device, which allows the operator to remove very precisely undesirable tissue and debris with maximal preservation of viable tissue. A retrospective study was performed to evaluate the efficacy, safety, and economic impact of using this technique of surgical debridement. Forty patients who had waterjet debridements were compared with 22 patients with matched wounds who had conventional surgical debridement. The waterjet group had significantly fewer procedures (p<0.002) than the conventional group. Based on these outcomes, the use of the new device in appropriate patients is expected to lead to cost savings of approximately 1,900 dollars per patient.

Versajet hydroscalpel: treatment of diabetic foot ulceration.

Treatment of diabetic foot ulceration continues to be a challenge to healthcare professionals. Wound healing can be affected in a number of ways, and it is of paramount importance that wound healing is achieved as quickly as possible to minimize the risk of amputation. One key aspect of management is wound debridement. A number of techniques can be employed, including, in severe cases, surgical debridement. These case histories illustrate where the novel Versajet hydroscalpel (Smith & Nephew) would be a useful tool for debriding a foot ulcer effectively without the patient undergoing orthopaedic surgery. The Versajet debrides quickly and efficiently, and a pink and granulating wound base was achieved in all cases. It should be considered for use in specialist centres where complex diabetic foot ulcers are treated and the expertise is available to use it.

Toward a common language: surgical wound bed preparation and debridement.

Wound management encompasses a number of disciplines. As new concepts and innovative technologies develop within this exciting field, it is important to share them in spite of the divergence of clinical perspectives between the expert disciplines. One such divergence exists between surgeons and nonsurgical wound specialists. As a result, there is a need to develop a common language between these two groups. How can we develop a common language that unites surgical expertise within medical wound management? One route may be through the principles of wound bed preparation, which we believe have great potential for the communication of effective surgical techniques. Another is through sharing our concepts of surgical debridement as it is applied to different wounds by a variety of surgical disciplines. In this monograph, we try to bring these two themes together. We discuss how wound bed preparation has added to our understanding of the pathophysiology of the nonhealing wound and has provided us with some general clinical concepts. We discuss what role debridement, and then specifically surgical debridement, has to play within wound bed preparation, before analyzing the importance of surgical debridement in tissue preservation and the control of infection. We finally look at ongoing work that examines the cost of various surgical debridement techniques. We will also review a new hydrosurgery system (VERSAJET, Smith and Nephew, Hull, UK), which we believe has an important role to play in the surgical preparation of the wound. We also expect that this paper will remind our medical colleagues about the critical role played by surgery in wound management.

Hydro-Jet technology in urologic surgery.

Hydro-Jet technology utilizes an extremely thin, high-pressure stream of water. This technology has been routinely used in industry as a cutting tool for different materials such as metal, ceramic, wood and glass. Recently, Hydro-Jet technology has been used for dissection and resection during open and laparoscopic surgical procedures. A high-pressure jet of water allows selective dissection and isolation of vital structures such as blood vessels and nerves. This has resulted in improved dissection and decreased complication rate in recent experimental and clinical studies. This technology has been successfully applied during open and laparoscopic partial nephrectomy, cholecystecomy and retroperitoneal lymphadenectomy.

Consensus of the German and Austrian Societies for Wound Healing and Wound Management on vacuum closure and the V.A.C. treatment unit.

Within the framework of the Three-Country Congress on V.A.C. Treatment (Vacuum Assisted Closure Treatment) held on May 16/17, 2003 in Salzburg, a Consensus Conference involving members of the Committees of the German and Austrian Societies for Wound Management was convened. In view of the divergence of opinion on the effectiveness of the treatment among the cost carriers, it appeared appropriate for the two Societies for Wound Healing in Germany and Austria to arrive at a consensus on the importance of and the indications for the management of wounds with the vacuum closure method. Since the first clinical applications in the nineteen-forties, both the indication spectrum and the number of applications have increased continually. In addition to diverse vacuum closure systems, there is patented computer-controlled system technology available that is established V.A.C. treatment. Although this is a hospital-based system, it can also be used on an outpatient basis by appropriately trained physicians and nursing staff and in instructed patients. For some indications, vacuum closure and V.A.C. management is considered the treatment of choice, since no equivalent alternative methods are available. A con-benefit analysis shows that vacuum closure and V.A.C. treatment is cost effective.

["Abdominal dressing" - a new method of treatment for open abdomen following secondary peritonitis]. / "Abdominal Dressing" - Eine neue Methode in der Behandlung des offenen Abdomens bei der sekundären Peritonitis.

INTRODUCTION: Treatment of open abdomen following secondary peritonitis is a challenge for surgery and intensive care units (ICU). The aim of this study was to compare three different concurrent treatment strategies. METHODS: Patients suffering an open abdomen following surgery for secondary peritonitis at the Department of General Surgery from 01/01 to 12/03 were investigated. Factor studied: duration of open abdomen, incidence of multi-organ failure, need for surgical revisions, length of stay (LOS) in ICU, nursing requirements (change of dressing/day), survival and integrity of abdominal wall after discharge. Treatment strategies included: open packing (OP), classic vacuum assisted (V.A.C.(R))-therapy with silicone net protection for the intestine (CV) and V.A.C.(R)-therapy with "abdominal dressing" a newly developed meshed polyvinyl wrap (AD). RESULTS: 21 patients were studied: 5 patients were treated with OP, 8 patients with CV and 8 patients with AD. Mean LOS was 65 (OP) vs. 53 (CV) vs. 42 (AD) days (NS), peritonitis related death was 3 (OP) vs. 1 (CV) vs. 0 (AD) (p < 0.05 Chisquare test). Median nursing effort was 4 dressings/day (OP), 0.5 (CV) and 0.5 (AD) (p < 0.005 OP vs CV, AD Kruskal-Wallis test). CONCLUSION: The "abdominal dressing"-therapy seems to be a more efficient treatment option in patients suffering from open abdomen following secondary peritonitis. A trend towards shorter ICU-LOS, lower mortality rates and reduced nursing requirements support our hypothesis.

[Results of vacuum therapy (v.a.C.) of superficial and deep dermal burns]. / Ergebnisse der Vakuumtherapie (V.A.C.-Therapie) von oberflächlich und tiefdermalen Verbrennungen.

BASIS: This prospective multi-centre study in co-operation with the Wake Forrest University covered the area of applications for treatment of fresh, superficial and deep dermal burns and scalds (grade II a-b). The micro-circulation relationships, wound healing time, extent of germ settlement and the connective tissue edema were of particular interest (together with the increase or decrease in burn depth). Moreover, the economical aspects were compared with conservative therapy. MATERIAL AND METHODS: his study was carried out on our intensive care ward on 11 patients suffering from burn injuries and we took the healing process as the basis (2001-2003). Inclusion criteria for the study were burns on both hands, degree II a-b, occurring trauma less than 6 hours ago and a treatment period of minimum 48 hours. In any case the hands inflicted with deeper and extensive burns (assessment by 2 experienced, independent appraising plastic surgeons) were subject to V.A.C. therapy. The standard conventional, conservative therapy applied to the other hand was taken for comparison or control purposes to determine the success. Since October 2001 we use the IC-View perfusography with ICG colouring (ICG pulsion, PULSION Medical Systems AG, Munich, Germany) for objective findings both previously and during the course of treatment. A respective quantitative analysis and assessment of the recorded video sequences were made with the help of special software (IC-CALC, PULSION Medical Systems AG, Munich, Germany). Here too, the intensity of the fluorescence indicated the blood circulation through the connective tissue and is on the same level. Basis for this method of study was the work of Holm et al. in our department. RESULTS: Above all, the results of our study revealed a significant reduction or prophylaxis of the connective tissue edema. Due to improvement in the micro-circulation, also supported by dynamic IC-View laser-fluorescence videography it could be determined that the wound healing process was quicker and without complication in the majority of cases. This was all the more true, although even when the extent of the deep dermal hand burns treated by V.A.C. therapy was greater than on the hand taken for comparison. Extending the therapy applied to the hand to the entire extremity could contribute to avoiding operative stress (escharotomy) in selected cases. Troublesome supporting of the hands and the ergotherapeutic use of splints were not necessary because of the exact fixation of the extremities ensured by the vacuum method. The advantage became more obvious when both the cost factor and time expenditure were considered and compared with previous conservative therapy. CONCLUSIONS: In the near future the treatment of superficial and deep dermal burns/scalds by V.A.C. therapy can help in reducing the expenditure in time, material and personnel when treating large area wounds. A further advantage is not only to be seen in the optimised healing process in the case of superficial and deep dermal burn wounds but also in the reduction or even avoidance of extensive escharotomy with the accompanying operation trauma. In this respect close mesh control of the blood circulating conditions appeared to us to be important and as a result of our study V.A.C. therapy was approved in December 2002 for the treatment of superficial and deep dermal burns by FDA (Dept. of Health and Human Services).

[V.A.C.-therapy and laser-induced fluorescence of indocyanine-green (IC-view), an assessment of wound perfusion in diabetic foot syndrome]. / V.A.C.(R)-Therapie und Laser-induzierte Fluoreszenz von Indozyaningrün (IC-VIEW) - eine Bestimmung der Wundperfusion beim Diabetischen Fusssyndrom.

Aim of the study was the use of IC-View for monitoring the effect of V.A.C.(R)-therapy on perfusion in diabetic wounds and the surrounding skin. We present data of ten patients with diabetic foot syndrome. Seven men and three women with age from 56 to 86 (mean 68) years were treated with V.A.C.(R)-therapy for 7 to 24 (mean 12) days. The perfusion index was calculated for the wound itself and for the surrounding skin before and at the end of V.A.C.(R)-therapy. The perfusion of the wound showed an increase under V.A.C.(R)-therapy of 31 % (6-62.5 %). The perfusion index calculated for the skin around the defect achieved an increase of 14 % (1.5-38 %). All defects were covered with meshed skin graft.

[Pressure conditions under VVS-foams - an experimental in-vitro- and in-vivo-analysis]. / Druckwerte unter VVS-Schwämmen - eine experimentelle In-vitro- und In-vivo-Untersuchung.

The aim of this study was to determine the pressure conditions in the tissue beneath and on the surface of wounds. This was done in vitro both on a plain surface and on a bovine muscle. In comparison we measured the pressure of the anterior tibial muscle of a patient with compartment syndrome. Besides, we applied negative pressure using just one drape connector and measured the pressure in different distances to look if the pressure is constant in large V.A.C.(R) dressings. Both polyurethane and polyvinyl alcohol foams were used.