Sergiu Fluieraru

New techniques for wound management: A systematic review of their role in the management of chronic wounds

Debridement is a crucial component of wound management. Recent technologies such as hydrosurgery (Versajet), ultrasound therapy (the MIST therapy device), or plasma-mediated bipolar radio-frequency ablation therapy (Coblation) seem to represent interesting alternatives for wound debridement. The purpose of this systematic review was to describe, evaluate, and compare these three recently developed methods for the management of chronic wounds. In January 2016, an electronic database search was conducted of MEDLINE, PubMed Central, and Embase for articles concerning these three innovative methods for the management of chronic wounds. A total of 389 references were identified by our search strategy, and 15 articles were included. We extracted data regarding the number and age of patients, indications, operating time, number of procedures, costs, wound healing time, decrease in exudation, perioperative blood loss, bacterial load, and the occurrence of complications. The 15 articles included studies that involved 563 patients who underwent hydrosurgery (7 studies), ultrasound therapy (6 studies), or Coblation (2 studies). Six randomized controlled trials were included that compared the use of a scalpel or curette to hydrosurgery (2 studies) or ultrasound therapy (6 studies). Hydrosurgery, in addition to being a very precise and selective tool, allows significantly faster debridement. Ultrasound therapy provides a significant reduction of exudation, and improves the wound healing time. No comparative study dedicated to Coblation was identified. Despite the obvious clinical interest of the topic, our review of the current literature revealed a lack of prospective randomized studies comparing these devices with each other or with standard techniques, particularly for Coblation and hydrosurgery.

Novel foam dressing using negative pressure wound therapy with instillation to remove thick exudate

We describe our experience with a novel foam dressing architecture in tandem with negative pressure wound therapy and instillation (NPWTi‐d) for removing viscous wound exudate and infectious materials. A retrospective review was conducted of the outcomes of 21 patients who received NPWTi‐d using a reticulated open cell foam instillation dressing with through holes (ROCF‐CC) designed to facilitate the removal of thick wound exudate and infectious materials. NPWTi‐d with ROCF‐CC was used to treat large complex chronic wounds with viscous wound exudate that contained substantial areas of devitalised tissue. Debridement was performed as appropriate or available. NPWTi‐d with ROCF‐CC assisted in loosening, solubilising and detaching viscous exudate, dry fibrin, wet slough and other infectious materials. Percent surface area of black non‐viable tissue and yellow fibrinous slough was reduced to ≤ 10% in 18/21 (85·7%) and 12/21 (57·1%) wounds, respectively, after an average of 1–3 applications (3–9 days) of NPWTi‐d with ROCF‐CC. Preliminary evidence suggests that adjunctive use of NPWTi‐d with ROCF‐CC may help clean large, complex wounds when complete surgical debridement is not possible or appropriate and/or when areas of slough and non‐viable tissue remain present on the wound surface.

L’apport d’une nouvelle mousse dans la thérapie par pression négative avec instillation dans la détersion des plaies

L’apport de l’instillation dans la therapie par pression negative concerne la possibilite de reduire la charge bacterienne locale en instillant et retirant periodiquement un liquide de trempage. Les recommandations recentes proposent l’utilisation de serum sale plutot que des solutions contenant un antiseptique ou un antibacterien. Le developpement d’une nouvelle mousse presentant des orifices regulierement repartis permet de retirer des tissus devitalises de la plaie. Si le risque de douleurs au retrait devra etre pris en charge, cette nouvelle mousse peut aider a la detersion des plaies profondes et presentant des tissus devitalises, et retarder la necessite d’une detersion chirurgicale.

Contrôle de la tension des berges cicatricielles après résection cutanée : un nouveau dispositif médical adhésif réglable

La mecanotherapie des cicatrices postoperatoires est consideree comme le traitement le plus efficace pour prevenir les cicatrices pathologiques hypertrophiques et cheloides. Plusieurs options sont ainsi utilisees en pratique courante. La technologie permettant a la fois de terminer la suture et de maintenir les berges cutanees au contact pendant plusieurs semaines est decrite dans cet article. Elle presente l’originalite de pouvoir rapprocher les deux bords et de regler la tension cutanee, et donne des resultats spectaculaires au prix de quelques semaines du port d’un adhesif peu allergisant a base d’hydrocolloides.

Recent Technologies in Necrosis Surgical Debridement

This chapter describes the updated methods and respective indications of recent surgical debridement technologies applied for the management of necrotic tissues.

Dissecting Haematomas in Patients Submitted to Anticoagulation

Large haematomas of the lower limbs are more frequently observed in patients submitted to anticoagulants. Skin necrosis are limited in size, but the blood collection largely extends below the apparent lesion, inducing a vast dissecting collected space with clinical consequences comparable to compartment syndrome, with muscular and tendinous consequences.