Patients and methods: We used the VHS for penile debridement in two patients. The first was 42-year-old Hispanic man involved in a truck-bike accident, who was dragged approximately 60 m after the collision. He presented with 25% body-surface abrasion impregnated with MP. The scrotal soft tissue had been lost and both testicles were exposed and ruptured, with no viable tissue. Moreover, the distal two-thirds of the penile urethra and the ventral glans were completely damaged and his penis entirely degloved. Several procedures were required for surgical debridement and reconstruction, including the skin grafting to 25% of his body surface. All surgical debridement was done with the VHS. A modified Thiersch-Duplay urethroplasty was used over a 16 F Foley catheter to reconstruct the missing urethra. The second patient was a 32-year-old man with no previous medical history, who presented with Fournier's gangrene after a penile abrasion following unprotected sexual intercourse. He required several surgical debridements. The VHS was applied to an 8 x 10 cm area, followed by a free-radial graft to the inferior epigastric.
Results: The clinical follow-up was 9 and 6 months, respectively; both patients had satisfactory granulation tissue and proper wound healing. Neither of the patients had infection after surgical debridement with the VHS, even when used in the case of Fournier's gangrene.
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Conclusion: The VHS appears to be effective for genital soft-tissue surgical debridement even when the tissue is impregnated with MP or infected, without causing any spread of infection. Larger series and a longer follow-up are needed to validate the effectiveness of the VHS in managing complex genital wounds.
Conclusions: Both scaling and root planing alone and scaling and root planing combined with flap procedure are effective methods for the treatment of chronic periodontitis in terms of attachment level gain and reduction in gingival inflammation. In the treatment of deep pockets open flap debridement results in greater PPD reduction and clinical attachment gain.
Files of Greater Taper (GT) are rotary nickel-titanium files of three tapers (0.06, 0.08, 0.10) with file tips of sizes 20, 30, and 40. The purpose of this study was to compare in an in situ model the efficacy of root canal debridement in the apical 3 mm when instrumenting to a GT size 20 or a GT size 40 at working length. Twenty matched human cadaver teeth with 32 canals were decoronated at the cementoenamel junction and instrumented with rotary Files of GT to either GT size 20 or GT size 40. Sodium hypochlorite, EDTA, and RC Prep were chemical aids for debridement. The teeth were extracted; decalcified; sectioned at 0.5 mm, 1.5 mm, and 2.5 mm from the apex; and prepared for histologic examination and quantification of remaining debris. No differences were found between each level within each apex size group; however, the GT size 20 group left significantly more debris in the apical third compared with the GT size 40 group. A regression analysis showed that the apical third cleanliness could be predicted mainly by instrument size and to a lesser extent by the canal length. Irrigant volume, number of instrument changes, and depth of penetration of irrigation needle were not likely to explain differences in debridement.
Wound debridement is the process of removing dead tissue from wounds. The dead tissue may be black, gray, yellow, tan, or white. Foreign material may also be on the wound. It may need to be removed. Your wound care doctor will let you know if dead tissue needs to be removed from your wound. Your physician or healthcare provider will talk to you about the procedure before he begins. He will talk to you about the different ways to remove the dead tissue. He will talk to you about the benefits of removing the dead tissue. He will also talk to you about the risks.
Wound debridement will speed up the healing process. This may cause some discomfort. It is generally tolerated well. Be sure to tell your doctor if you experience pain or discomfort when the dead tissue is being removed. He will take measures to make you more comfortable. We want you to be as comfortable as possible as we help heal your wound as fast as possible.
Debridement can play a vital role in wound bed preparation and the removal of barriers that impair wound healing. In accordance with the TIME principles, debridement can help remove nonviable tissue, control inflammation or infection, decrease excess moisture, and stimulate a nonadvancing wound edge. There are many types of debridement, each with a set of advantages and disadvantages that must be clearly understood by the healthcare team. Failure to use the correct debridement method for a given type of wound may lead to further delays in healing, increase patient suffering, and unnecessarily increase the cost of care. This review article discusses the various methods of debridement, describes currently available debriding agents, evaluates the clinical data regarding their efficacy and safety, and describes strategies for the management of problematic nonhealing wounds.
Aim: The objective was to determine clinical and microbiological effects and perceived treatment discomfort of root debridement by subgingival air polishing compared with ultrasonic instrumentation during supportive periodontal therapy (SPT).
Material and methods: The trial was conducted as a split-mouth designed study of 2-month duration including 20 recall patients previously treated for chronic periodontitis. Sites with probing pocket depth (PPD) of 5-8 mm and bleeding on probing (BoP+) in two quadrants were randomly assigned to subgingival debridement by (i) glycine powder/air polishing applied with a specially designed nozzle or (ii) ultrasonic instrumentation. Clinical variables were recorded at baseline, 14 and 60 days post-treatment. Primary clinical efficacy variable was PPD reduction. Microbiological analysis of subgingival samples was performed immediately before and after debridement, 2 and 14 days post-treatment.
Results: Both treatment procedures resulted in significant reductions of periodontitis-associated bacterial species immediately and 2 days after treatment, and in significant reduction in BoP, PPD and relative attachment level at 2 months. There were no statistically significant differences between the treatment procedures at any of the examinations intervals. Perceived treatment discomfort was lower for air polishing than ultrasonic debridement.
Conclusion: This short-term study revealed no pertinent differences in clinical or microbiological outcomes between subgingival air polishing and ultrasonic debridement of moderate deep pockets in SPT patients.
Abstract:Debridement is the removal of infected, contaminated, damaged, devitalized, necrotic, or foreign tissue from a wound. The codes in this local coverage determination (LCD) cover debridement of skin, subcutaneous tissue, fascia, muscle, bone and removal of foreign material. Debridement promotes wound healing by reducing sources of infection and other mechanical impediments to healing. Its goal is to cleanse the wound, reduce bacterial contamination and provide an optimal environment for wound healing or possible surgical intervention. The usual end point of debridement is removal of pathological tissue and/or foreign material until healthy tissue is exposed. Debridement techniques include, among others, sharp and blunt dissection, curettement, scrubbing, and forceful irrigation. Surgical instruments may include a scrub brush, irrigation device, electrocautery, laser, sharp curette, forceps, scissors, burr or scalpel. Prior to debridement, determination of the extent of an ulcer/wound may be aided by the use of blunt probes to determine wound/ulcer depth and to disclose abscess and sinus tracts.This LCD does not apply to debridement of burned surfaces. Regulations concerning the use of debridement of burned surfaces codes are not addressed in this LCD. This LCD does not apply to debridement of nails and the provider is referred to NGS LCD Routine Foot Care and Debridement of Nails (L33636).Indications: Debridement is indicated for any wound requiring removal of deep seated foreign material, devitalized or nonviable tissue at the level of skin, subcutaneous tissue, fascia, muscle or bone, to promote optimal wound healing or to prepare the site of appropriate surgical intervention.
Conditions that may require debridement of large amounts of skin include: rapidly spreading necrotizing process (sometimes seen with aggressive streptococcal infections), severe eczema, bullous skin diseases, extensive skin trauma (including large abraded areas with ground-in dirt), or autoimmune skin diseases (such as pemphigus).
Debridement services for subcutaneous tissue muscle or fascia or bone are appropriate for treatment of skin ulcers, circumscribed dermal infections, conditions affecting contiguous deeper structures, and debridement of deep-seated debris from any number of injury types.
The number of debridement services required is variable and depends on numerous intrinsic and extrinsic factors. Debridement services are covered provided all significant relevant comorbid conditions are addressed that could interfere with optimal wound healing. Limitations:
If there is no necrotic, devitalized, fibrotic, or other tissue or foreign matter present that would interfere with wound healing, the debridement service is not medically necessary. The presence or absence of such tissue or foreign matter must be documented in the medical record.
Skin breakdown under a dorsal corn is not considered an ulcer and generally does not require debridement. These lesions typically heal without significant surgical intervention beyond removal of the corn and shoe modification 2ff7e9595c
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