The Experts below are selected from a list of 30270 Experts worldwide ranked by ideXlab platform
Keith Harding - One of the best experts on this subject based on the ideXlab platform.
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serial surgical Debridement a retrospective study on clinical outcomes in chronic lower extremity wounds
Wound Repair and Regeneration, 2009Co-Authors: Matthew Cardinal, David E Eisenbud, David Armstrong, Charles M Zelen, Vickie R Driver, Christopher E Attinger, Tania J Phillips, Keith HardingAbstract:This investigation was conducted to determine if a correlation exists between wound healing outcomes and serial Debridement in chronic venous leg ulcers (VLUs) and diabetic foot ulcers (DFUs). We retrospectively analyzed the results from two controlled, prospective, randomized pivotal trials of topical wound treatments on 366 VLUs and 310 DFUs over 12 weeks. Weekly wound surface area changes following Debridement and 12-week wound closure rates between centers and patients were evaluated. VLUs had a significantly higher median wound surface area reduction following clinical visits with surgical Debridement as compared with clinical visits with no surgical Debridement (34%, p=0.019). Centers where patients were debrided more frequently were associated with higher rates of wound closure in both clinical studies (p=0.007 VLU, p=0.015 DFU). Debridement frequency per patient was not statistically correlated to higher rates of wound closure; however, there was some minor evidence of a positive benefit of serial Debridement in DFUs (odds ratio-2.35, p=0.069). Our results suggest that frequent Debridement of DFUs and VLUs may increase wound healing rates and rates of closure, though there is not enough evidence to definitively conclude a significant effect. Future clinical research in wound care should focus on the relationship between serial surgical wound Debridement and improved wound healing outcomes as demonstrated in this study.
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effect of sharp Debridement using curette on recalcitrant nonhealing venous leg ulcers a concurrently controlled prospective cohort study
Wound Repair and Regeneration, 2005Co-Authors: Dean T Williams, Stuart Enoch, D R Miller, Karen Harris, Patricia Elaine Price, Keith HardingAbstract:The objective of this study was to evaluate the effect of sharp Debridement on the progression of recalcitrant chronic venous leg ulcers (CVLU) and to assess the feasibility of performing this procedure in an outpatient setting. We performed a prospective study of 55 CVLU (53 patients) over a 12-month period. The study group, which underwent Debridement, contained 28 CVLU whose wound beds had slough, nonviable tissue, and no granulation tissue. The control group was 27 CVLU with minimal (15–20%) granulation tissue, but no slough or nonviable tissue. Treatments were otherwise similar. Age, body mass index, mean ulcer surface area (MSA) and mean ulcer duration were comparable in both groups. Ulcer measurements were taken at 4 weeks before Debridement, at the time of Debridement, and 4 and 20 weeks post-Debridement. There was no change in the MSA from 4 weeks before to the time of Debridement in either group. At 4 weeks post-Debridement, the study ulcers showed a 6 cm2 reduction in the MSA vs. a 1 cm2 reduction in controls (P = 0.02). By week 20 post-Debridement, the study ulcers achieved a 7.4 cm2 reduction in the MSA vs. an increase of 1.3 cm2 in controls (P = 0.008). Between weeks 8 and 20 post-Debridement, 16% of study ulcers vs. 4.3% of control ulcers achieved complete healing. Infection rates and antimicrobial usage were similar. We conclude that sharp Debridement is effective in stimulating healing of recalcitrant CVLU. It is safe, well tolerated, and can be performed in an outpatient setting.
Stephen C Weber - One of the best experts on this subject based on the ideXlab platform.
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arthroscopic Debridement and acromioplasty versus mini open repair in the treatment of significant partial thickness rotator cuff tears
Arthroscopy, 1999Co-Authors: Stephen C WeberAbstract:Abstract Summary: Partial tears of the rotator cuff, especially of the articular side, have received attention only with the recent ability of magnetic resonance imaging (MRI) and arthroscopy to diagnose these lesions. Several early reports showed nearly 100% success in managing these lesions with arthroscopic Debridement with or without acromioplasty. This series compares 32 patients with significant partial-thickness rotator cuff tears treated with Debridement and acromioplasty versus 33 patients with mini-open repair. Follow-up was from 2 to 7 years. Preoperative MRI was not useful; when positive, preoperative arthrography was useful for articular side tears. Of the tears, 12% were bursal side tears and the remainder were articular side tears; all were at least 50% or more of the thickness of the tendon. A significant number of the arthroscopic group had fair results by UCLA score criteria. Three patients reruptured the remaining cuff later despite adequate acromioplasty. Healing of the partial tear was never observed at second-look arthroscopy. Although postoperative pain was significantly greater and recovery slower with open repair, no patient was reoperated on and rerupture of the repair did not occur. The outstanding results of prior studies of cuff Debridement were not duplicated in this series of cuff Debridements with long-term follow-up. Adequate acromioplasty alone does not prophylactically prevent rotator cuff tear progression. Recognition and repair of these significant partial tears may be advisable for the long-term function of the shoulder despite short-term improvement in morbidity with arthroscopic treatment. Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 15, No 2 (March), 1999: pp 126–131
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arthroscopic Debridement and acromioplasty versus mini open repair in the treatment of significant partial thickness rotator cuff tears
Arthroscopy, 1999Co-Authors: Stephen C WeberAbstract:Partial tears of the rotator cuff, especially of the articular side, have received attention only with the recent ability of magnetic resonance imaging (MRI) and arthroscopy to diagnose these lesions. Several early reports showed nearly 100% success in managing these lesions with arthroscopic Debridement with or without acromioplasty. This series compares 32 patients with significant partial-thickness rotator cuff tears treated with Debridement and acromioplasty versus 33 patients with mini-open repair. Follow-up was from 2 to 7 years. Preoperative MRI was not useful; when positive, preoperative arthrography was useful for articular side tears. Of the tears, 12% were bursal side tears and the remainder were articular side tears; all were at least 50% or more of the thickness of the tendon. A significant number of the arthroscopic group had fair results by UCLA score criteria. Three patients reruptured the remaining cuff later despite adequate acromioplasty. Healing of the partial tear was never observed at second-look arthroscopy. Although postoperative pain was significantly greater and recovery slower with open repair, no patient was reoperated on and rerupture of the repair did not occur. The outstanding results of prior studies of cuff Debridement were not duplicated in this series of cuff Debridements with long-term follow-up. Adequate acromioplasty alone does not prophylactically prevent rotator cuff tear progression. Recognition and repair of these significant partial tears may be advisable for the long-term function of the shoulder despite short-term improvement in morbidity with arthroscopic treatment.
Walter G Wolfe - One of the best experts on this subject based on the ideXlab platform.
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evaluation of vacuum assisted closure in the treatment of poststernotomy mediastinitis
The Journal of Thoracic and Cardiovascular Surgery, 2003Co-Authors: Patrick W Domkowski, Scott L Levin, Monica L Smith, Denis L Gonyon, Carol Drye, Mary Kay Wooten, Walter G WolfeAbstract:Abstract Objective Poststernotomy mediastinitis, although infrequent, is a potentially life-threatening complication of cardiac surgery that continues to have a significant morbidity and mortality despite aggressive therapy. Vacuum-assisted closure uses controlled suction to provide evacuation of wound fluid, decrease bacterial colonization, stimulate granulation tissue, and reduce the need for dressing changes. Methods One hundred two patients from Duke University Hospital, The Durham Veterans Administration Hospital, and referring institutions underwent vacuum-assisted closure treatment. There were 63 men and 39 women, with a mean age of 67. The infection was noticed between postoperative days 8 and 34, at which time the wounds were opened and debrided. Results Ninety-six of the 102 patients received vacuum-assisted therapy while the remaining 6 underwent daily multiple dressing changes without vacuum-assisted therapy. Fifty-three of the 96 patients required only sternal Debridement, followed by wound vacuum therapy and closure by secondary intention, while the remaining 43 had an additional procedure. Of these, 33 patients underwent omental transposition and 10 patients had a pectoralis flap. The length of stay for all patients was 27 ± 12 days. This was related in part to intravenous antibiotics. Hospital mortality for all patients was 3.7% (4 patients). Two of these patients underwent vascular flap and succumbed to multisystemic organ failure, while the other 2 received only wound vacuum therapy following Debridement and succumbed to overwhelming sepsis. Conclusion Vacuum-assisted drainage is an effective therapy for mediastinitis following debribement or before placement of a vascularized tissue flap.
Jennifer Heller - One of the best experts on this subject based on the ideXlab platform.
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the impact of race on advanced chronic venous insufficiency
Annals of Vascular Surgery, 2016Co-Authors: Anahita Dua, Sapan S Desai, Jennifer HellerAbstract:Background The study aimed to determine the association between race and patient variables, hospital covariates, and outcomes in patients presenting with advanced chronic venous insufficiency. Methods The National Inpatient Sample was queried to identify all Caucasian and African-American patients with a primary International Classification of Diseases, Ninth Revision (ICD-9) diagnosis code for venous stasis with ulceration (454.0), inflammation (454.1), or complications (454.2) from 1998 to 2011. CEAP scores were correlated with ICD-9 diagnosis. Demographics, CEAP classification, management, cost of care, length of stay (LOS), and inpatient mortality were compared between races. Statistical analysis was via descriptive statistics, Student’s t-test, and the Fisher’s exact test. Trend analysis was completed using the Mann–Kendall test. Results A total of 20,648 patients were identified of which 85% were Caucasian and 15% were African-American. Debridement procedures had the highest costs at $6,096 followed by skin grafting at $4,089. There was an overall decrease in the number of ulcer Debridements, vein stripping, and sclerotherapy procedures between 1998 and 2011 (P Conclusions African-American patients with a primary diagnosis of venous stasis present with more advanced venous disease at a younger age compared with their Caucasian counterparts. This is associated with increased ulcer Debridement, deep vein thrombosis rates and hospital charges in the African-American cohort. There are no differences in sclerotherapy or skin grafting procedures, LOS or inpatient mortality between races.
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the impact of race on advanced chronic venous insufficiency
Journal of vascular surgery. Venous and lymphatic disorders, 2015Co-Authors: Anahita Dua, Sapan S Desai, Jennifer HellerAbstract:Background: The study aimed to determine the association between race and patient variables, hospital covariates, and outcomes in patients presenting with advanced chronic venous insufficiency. Methods: The National Inpatient Sample was queried to identify all Caucasian and AfricanAmerican patients with a primary International Classification of Diseases, Ninth Revision (ICD-9) diagnosis code for venous stasis with ulceration (454.0), inflammation (454.1), or complications (454.2) from 1998 to 2011. CEAP scores were correlated with ICD-9 diagnosis. Demographics, CEAP classification, management, cost of care, length of stay (LOS), and inpatient mortality were compared between races. Statistical analysis was via descriptive statistics, Student’s t-test, and the Fisher’s exact test. Trend analysis was completed using the ManneKendall test. Results: A total of 20,648 patients were identified of which 85% were Caucasian and 15% were African-American. Debridement procedures had the highest costs at $6,096 followed by skin grafting at $4,089. There was an overall decrease in the number of ulcer Debridements, vein stripping, and sclerotherapy procedures between 1998 and 2011 (P < 0.05) for both groups. However, African-American patients had significantly more ulcer Debridements than their Caucasian counterparts. Conclusions: African-American patients with a primary diagnosis of venous stasis present with more advanced venous disease at a younger age compared with their Caucasian counterparts. This is associated with increased ulcer Debridement, deep vein thrombosis rates and hospital charges in the African-American cohort. There are no differences in sclerotherapy or skin grafting procedures, LOS or inpatient mortality between races.
Peter F M Choong - One of the best experts on this subject based on the ideXlab platform.
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outcome of Debridement and retention in prosthetic joint infections by methicillin resistant staphylococci with special reference to rifampin and fusidic acid combination therapy
Antimicrobial Agents and Chemotherapy, 2013Co-Authors: Trisha Peel, Kirsty Buising, Michelle M Dowsey, Craig A Aboltins, John Daffy, Peter Stanley, Peter F M ChoongAbstract:ABSTRACT The management of prosthetic joint infections remains a clinical challenge, particularly infections due to methicillin-resistant staphylococci. Previously, this infection was considered a contraindication to Debridement and retention strategies. This retrospective cohort study examined the treatment and outcomes of patients with arthroplasty infection by methicillin-resistant staphylococci managed by Debridement and retention in conjunction with rifampin-fusidic acid combination therapy. Over an 11-year period, there were 43 patients with infection by methicillin-resistant staphylococci managed with Debridement and retention. This consisted of close-interval repeated arthrotomies with pulsatile lavage. Rifampin was combined with fusidic acid for the majority of patients (88%). Patients were monitored for a median of 33.5 months (interquartile range, 20 to 54 months). Overall, 9 patients experienced treatment failure, with 12- and 24-month estimates of infection-free survival of 86% (95% confidence interval [CI], 71 to 93%) and 77% (95% CI, 60 to 87%), respectively. The following factors were associated with treatment failure: methicillin-resistant Staphylococcus aureus (MRSA) arthroplasty infection, a single surgical Debridement or ≥4 Debridements, and the receipt of less than 90 days of antibiotic therapy. Patients with infection by methicillin-resistant coagulase-negative staphylococci (MR-CNS) were less likely to fail treatment. The overall treatment success rate reported in this study is comparable to those of other treatment modalities for prosthetic joint infections by methicillin-resistant staphylococci. Therefore, the Debridement and retention of the prosthesis and rifampin-based antibiotic therapy are a valid treatment option for carefully selected patients.
