Surgical Debridement
Surgical debridement in chronic wounds plays pivotal roles. Debridement is considered to fasten the wound healing rate and time and reduce the wound area by removing necrotic wound bed, wound edge tissue like hyperkeratotic epidermis, necrotic dermis, for
- PDF / 891,078 Bytes
- 7 Pages / 504.57 x 720 pts Page_size
- 7 Downloads / 201 Views
42
Sadanori Akita
42.1
Contents 42.1
Introduction ..............................................
42.2
Pathophysiology of the Underlying Diseases and Conditions in Surgical Debridement ............................................. Burns .......................................................... High-Energy Wound .................................. Pressure Ulcer ............................................ Diabetic Foot Ulcer .................................... Leg Ulcer ...................................................
258 258 258 258 261 261
Choice of the Surgical Debridement .............................................
262
References ...............................................................
263
42.2.1 42.2.2 42.2.3 42.2.4 42.2.5 42.3
S. Akita, MD, PhD Division of Plastic Surgery, Department of Developmental and Reconstructive Medicine, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki 8528501, Japan e-mail: [email protected]
Introduction
257
Surgical debridement in chronic wounds plays pivotal roles. Debridement is considered to fasten the wound healing rate and time and reduce the wound area by removing necrotic wound bed, wound edge tissue like hyperkeratotic epidermis, necrotic dermis, foreign debris, and bacterial pathogens, which bring inhibitory effects on wound healing [1]. There is marked cytoplasmic reduction and localization of epidermal growth factor receptor (EGFR) in the epidermis by microarray analysis, which indicates that the nonhealing keratinocytes have attenuated capacity to respond to EGF. Along with epidermal and keratinocyte inhibition, fibroblasts derived from nonhealing wounds demonstrate slower migration [2]. All these information with molecular analysis suggest that proper surgical debridement may be a reasonable solution to overcome this problem. Surgical debridement is considered one of the essential choices in accelerating and optimizing the wound healing; however, the evidences of this technique and rationale should be further discussed in each pathologic condition such as leg and diabetic foot ulcer. As in all cases of wound healing, the patient should be nutritionally optimized prior to surgical debridement. If any of these criteria are not met, it is in the best interest of surgeon, physician, and patient to delay the wound closure until conditions are reaching more ideal. Both chronic and acute wounds can be improved by debridement.
L. Téot et al. (eds.), Skin Necrosis, DOI 10.1007/978-3-7091-1241-0_42, © Springer-Verlag Wien 2015
257
S. Akita
258
A wound that can produce granulation tissue in the absence of bacterial overload is generally ready for subsequent skin grafting, temporally converge with artificial dermis or flap if necessary. In wounds that fail to develop a bed of granulation tissue, bioactive dressings or topical growth factors may be employed.
42.2
Pathophysiology of the Underlying Diseases and Conditions in Surgical Debridement
42.2.1 Burns In the deep burn (third-degree burn, penetrated thro
Data Loading...
