Toward a common language: surgical wound bed preparation and debridement

Abstract

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.

Differentiation Potential of Multipotent Progenitor Cells Derived from War-Traumatized Muscle Tissue

“…The osteogenic potential of these cells suggests their possible role in the pathological processes that result in ectopic bone formation 22 . Accordingly, it would be of interest to study how these progenitor cells respond to biochemical factors in the wound-healing environment during the regenerative process.…”

“…Although removal of tissue from wounds that are characterized by substantial tissue loss is counterintuitive, it is essential for definitive treatment, wound closure, and proper healing [22][23][24] . The results of the present study suggest that this waste tissue may possess cellular building blocks that might be useful in future treatment and tissue-regeneration strategies.…”

Autonomous multilateral debridement with the Raven surgical robot

“…In this work, we focus on autonomous execution of a tedious surgical sub-task known as surgical debridement [2], [10], which involves removing damaged tissue from an affected area to allow the surrounding tissue to heal. We note that prior work has addressed the problem of designing planning and control algorithms for autonomous execution of other surgical sub-tasks such as knot tying or suturing [28], [39] and tissue retraction during surgery [22], [14].…”

“…Surgical debridement is a tedious surgical sub-task in which dead or damaged tissue is removed from the body to allow the remaining healthy tissue to heal faster [2], [10].…”

“…Surgical debridement is a tedious surgical sub-task in which dead or damaged tissue is removed from the body to allow the remaining healthy tissue to heal [2], [10]. Autonomous surgical debridement requires perception to locate fragments, grasp and motion planning to determine collision free trajectories for one or more arms and grippers to grasp them, and control to deposit them into a receptacle (see Fig.…”