Treatment of Diabetic (Neuropathic) Foot Ulcers with Two-Stage Debridement and Closure

Kumagai, S; Mahoney, Craig R.; Fitzgibbons, Timothy C.; McMullen, Scott T.; Connolly, Thomas L.; Henkel, Loree

doi:10.1177/107110079801900309

Cited by 25 publications

(12 citation statements)

References 17 publications

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“…Clinical case studies and series also provide some data, e.g., Kumagai et al, 21 where two-stage surgical debridement was used to bring about successful healing of refractory ulcers.…”

Section: Does Debridement Really Work?mentioning

confidence: 99%

Toward a common language: surgical wound bed preparation and debridement

Granick

Boykin

Gamelli

et al. 2006

Wound Repair Regeneration

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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.

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“…Clinical case studies and series also provide some data, e.g., Kumagai et al, 21 where two-stage surgical debridement was used to bring about successful healing of refractory ulcers.…”

Section: Does Debridement Really Work?mentioning

confidence: 99%

Toward a common language: surgical wound bed preparation and debridement

Granick

Boykin

Gamelli

et al. 2006

Wound Repair Regeneration

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“…A range of foot-salvaging surgical interventions have been described, including debridement to bleeding bone marrow with epidermal sheet grafting [43], two-stage debridement with secondary closure [44] and limb amputation [45,46]. We did not include other surgical techniques described in methodologically inferior studies.…”

Section: Choice Of Surgical Interventionmentioning

confidence: 99%

Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment

Berendt

Peters

Баккер³

et al. 2008

Diabetes Metab. Res. Rev.

276

214

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SummaryThe International Working Group on the Diabetic Foot appointed an expert panel to provide evidence-based guidance on the management of osteomyelitis in the diabetic foot. Initially, the panel formulated a consensus scheme for the diagnosis of diabetic foot osteomyelitis (DFO) for research purposes, and undertook a systematic review of the evidence relating to treatment. The consensus diagnostic scheme was based on expert opinion; the systematic review was based on a search for reports of the effectiveness of treatment for DFO published prior to December 2006.The panel reached consensus on a proposed scheme that assesses the probability of DFO, based on clinical findings and the results of imaging and laboratory investigations.The literature review identified 1168 papers, 19 of which fulfilled criteria for detailed data extraction. No significant differences in outcome were associated with any particular treatment strategy. There was no evidence that surgical debridement of the infected bone is routinely necessary. Culture and sensitivity of isolates from bone biopsy may assist in selecting properly targeted antibiotic regimens, but empirical regimens should include agents active against staphylococci, administered either intravenously or orally (with a highly bioavailable agent). There are no data to support the superiority of any particular route of delivery of systemic antibiotics or to inform the optimal duration of antibiotic therapy. No available evidence supports the use of any adjunctive therapies, such as hyperbaric oxygen, granulocyte-colony stimulating factor or larvae.We have proposed a scheme for diagnosing DFO for research purposes. Data to inform treatment choices in DFO are limited, and further research is urgently needed.

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“…The area of acute skin trauma should be thoroughly cleansed and debrided before dressings are applied. 4,[46][47][48][49][50][51][52][53] Strength of recommendation: B 13. Debridement should continue until well-vascularized, healthy granulation or epithelial tissue is exposed.…”

Section: Recommendationsmentioning

confidence: 99%

National Athletic Trainers' Association Position Statement: Management of Acute Skin Trauma

Beam

Buckley

Holcomb

et al. 2016

Journal of Athletic Training

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Objective: To present recommendations for the cleansing, debridement, dressing, and monitoring of acute skin trauma in patients.Background: Acute skin trauma is common during participation in athletic and recreational activities. Clinical decisions and intervention protocols after injury vary among athletic trainers and are often based on ritualistic practices. An understanding of cleansing, debridement, and dressing techniques; clinical features of infection and adverse reactions; and monitoring of acute skin trauma is critical for certified athletic trainers and other allied health and medical professionals to create a local wound environment that promotes healing and lessens the risk of complications.Recommendations: These guidelines are intended to provide the certified athletic trainer and others participating in athletic health care with specific knowledge about and recommendations for the management of acute skin trauma.Key Words: abrasions, avulsions, blisters, incisions, lacerations, punctures, cleansing, debridement, nonocclusive dressings, occlusive dressings, infection, adverse reactions T raumatic injury to the skin is common among athletes participating in all sports.1 The exact frequencies of abrasions, avulsions, blisters, incisions, lacerations, and punctures are difficult to calculate because many patients do not seek medical attention after injury; for others, their activity level is initially unaffected, and the injury is not recorded on surveillance reports. Unreported skin trauma and inappropriate wound management can result in delayed healing, cross-contamination, bacterial colonization, and infection, adversely affecting the overall health and playing status of the patient. Managing acute skin trauma through appropriate cleansing, debridement, and dressing techniques can create an environment conducive to healing and lessen the risk of complications. 2,3Wound-management techniques have undergone drastic changes over the last 50 years, and other allied health care professions, organizations, and facilities have developed guidelines that serve as standards of care. [4][5][6] However, guidelines for the management of acute skin trauma by athletic trainers (ATs) are limited in the literature.1,7 The development and implementation of cleansing, debridement, and dressing techniques for acute skin trauma are critical for ATs to successfully deliver health care services to patients. The following review and recommendations provide information on the management of acute skin trauma and guidelines for ATs and other allied health and medical professionals who care for patients. RECOMMENDATIONSThis position statement is based on current research and literature with regard to the cleansing, debridement, dressing, and monitoring of acute skin trauma. We independently categorized the studies and literature using the Strength of Recommendation Taxonomy (SORT) developed by the American Academy of Family Physicians. 8 The taxonomy grades the quality of the data from the literature (level of evidence) and p...

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Treatment of Diabetic (Neuropathic) Foot Ulcers with Two-Stage Debridement and Closure

Cited by 25 publications

References 17 publications

Toward a common language: surgical wound bed preparation and debridement

Toward a common language: surgical wound bed preparation and debridement

Diabetic foot osteomyelitis: a progress report on diagnosis and a systematic review of treatment

National Athletic Trainers' Association Position Statement: Management of Acute Skin Trauma

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