Anghel EL, DeFazio MV, Barker JC, Janis JE, Attinger CE, et al.
Plastic and reconstructive surgery. Date of publication 2016 Sep 1;volume 138(3 Suppl):82S-93S.
1. Plast Reconstr Surg. 2016 Sep;138(3 Suppl):82S-93S. doi:
10.1097/PRS.0000000000002651.
Current Concepts in Debridement: Science and Strategies.
Anghel EL(1), DeFazio MV, Barker JC, Janis JE, Attinger CE.
Author information:
(1)Washington, DC; and Columbus, Ohio From the Department of Plastic Surgery,
MedStar Georgetown University Hospital; and Department of Plastic Surgery, Ohio
State University Medical Center.
Comment in
Plast Reconstr Surg. 2017 Apr;139(4):1026e-1028e.
BACKGROUND: The establishment of a healthy wound bed through adequate debridement
of infected, senescent, and/or devitalized tissue is central to the progression
of normal wound healing. Although a variety of surgical and nonsurgical
strategies have been proposed, none have proven completely effective in all
settings. This review focuses on the principles and techniques of modern
debridement practices employed in the management of complex wounds.
METHODS: A comprehensive review of the PubMed/Medline and Ovid databases was
performed to identify basic science and clinical studies using key words most
relevant to biofilm, debridement, and wound healing. English language articles
that were peer reviewed and that met the standard of evidence-based medicine were
included. Level of evidence for various debridement approaches was rated
utilizing the American Society of Plastic Surgeons Rating Levels of Evidence and
Grading Recommendations.
RESULTS: The value of both operative and nonoperative debridement techniques,
their indications, and limitations are described. With an emphasis placed on
surgical debridement, this review highlights technical adjuncts that can be used
to optimize wound bed preparation, including preoperative topical staining of the
wound, as well as the use of color-guided endpoints to prevent removal of excess
healthy tissue. The indications for using temporizing measures for wound control
such as negative pressure wound therapy with and without installation are also
discussed.
CONCLUSION: Optimal management requires a multimodal approach that centers around
operative debridement and incorporates the use of adjunctive measures to
facilitate the removal of infected tissue, biofilm, and/or senescent cells that
impede the progression of normal wound healing.
DOI: 10.1097/PRS.0000000000002651
PMID: 27556779 [Indexed for MEDLINE]
