"Soap Scrap" Technique: A Tissue-Preserving Approach to Treating Wounds with Undermining or Pockets.

ABSTRACT: This retrospective case series introduces a tissue-preserving approach to treat complicated wounds with undermined edges or wounds with pockets. Wounds with undermining or pockets are commonly encountered in clinical practice and can be difficult to manage when trying to achieve wound closure. Traditionally, epibolic edges need to be resected or cauterized with silver nitrate, whereas wound undermining or pockets need to be resected or unroofed. The method described herein consists of three components: sharp debridement of all undermined areas or inside walls of wound pockets, compression, and immobilization. Compression can be performed using multilayered compression alone, modified negative-pressure therapy, or both. Immobilization of all wound layers can be achieved using a brace, removable Cam Walker, or a cast.This article reports on 11 patients who had unfavorable upper and lower extremity wounds with undermined areas or wound pockets who were treated using this methodology. The average patient age was 73 years, and the average wound depth was 1.12 cm. The average undermined area was 1.7 (range, 0.2-5.0) cm. Wounds healed in an average of 9.1 weeks; all wounds healed between 3 and 15 weeks. This series demonstrates a novel tissue-preserving approach to treating wounds with undermining or wounds with pockets using debridement, immobilization, and compression.

"Soap Scrap" Technique: A Tissue-Preserving Approach to Treating Wounds With Undermining or Pockets.

ABSTRACT: The case series aims to introduce a novel tissue-preserving approach to treat complicated wounds with undermined edges or wounds with pockets. Wounds with undermining and wounds with pockets are commonly encountered in clinical practice and can be difficult to manage when trying to achieve wound closure. Traditionally, epibolic edges need to be resected or cauterized with silver nitrate, whereas, wound undermining or pockets need to be resected or unroofed. This case series evaluates the use of this novel tissue-preserving approach to the treatment of undermined areas and wound pockets.This method consists of three components: sharp debridement of all undermined areas or inside walls of wound pockets, compression, and immobilization. Compression can be performed using multilayered compression alone, modified negative pressure therapy (NPWT), or both. Immobilization of all wound layers can be achieved using a brace, removable Cam Walker, or a cast.This is a retrospective case series. This article present 11 patients with unfavorable wounds due to undermined areas or wound pockets who were treated using this methodology. The average patient age was 73 years old, including wounds of the upper and lower extremities. The average wound depth was 1.12 cm. The average undermined area was 1.7 cm, undermined areas ranging from 0.2 to 5 cm. Wounds healed on average in 9.1 weeks; all wounds healed between 3 to 15 weeks. This series demonstrates a novel tissue-preserving approach to treating wounds with undermining or wounds with pockets using debridement, immobilization, and compression.

Edge trenching: a case study of a novel debridement technique.

Debridement is a vital part of wound bed preparation; however, even a perfectly debrided wound may stall if it has vertical edges or the tissue in the wound base does not merge with the wound edges. A novel debridement technique described in this case study allows wound remodelling to overcome these difficulties.

Treatment of Recurrent Pressure Injury Using an Allograft Adipose Matrix.

ABSTRACT: A 77-year-old man with a more than 10-year history of a spinal cord injury developed bilateral trochanteric stage 3 pressure injuries (PIs) several years ago. They initially healed. The right trochanteric PI opened again and continued to reopen every 2 to 3 months, likely because of deficient adipose layer in the area of the healed PI.To treat the recurrent PI, providers injected a total of 3 mL of allograft adipose matrix into the ulcerated area of the right trochanter PI in a fanning fashion to increase subcutaneous cushioning over the bony prominence. Silicone foam was used to assist with pressure reduction for the first month. When the ulcerations healed at 1 month, the silicone foam was discontinued, and an emollient ointment was applied bilaterally to provide both the currently affected site and healed scar tissue with moisture and enhanced barrier function. Follow-up examinations were completed at 1, 3, 7, 11, 14, 16, 19, 22, and 24 months; the ulcerations remained closed, and no new PIs developed.The authors propose that allograft adipose matrix is a potential treatment modality for recurrent PIs needing a supplemented subcutaneous layer that other modalities cannot provide. Further use is ongoing in clinical scenarios when there is deficient adipose layer such as recurrent PIs or to prevent PI deterioration in early stages.

Linezolid for the treatment of Nocardia spp. infections.

OBJECTIVE: To review the available evidence regarding the use of linezolid for the treatment of Nocardia spp. infections. DATA SOURCES: Data were identified through a search of MEDLINE (1966-May 2007), American Search Premier (1975-May 2007), International Pharmaceutical Abstracts (1960-2007), Science Citation Index Expanded (1996-2007), and Cochrane Databases (publications archived until May 2007) using the terms linezolid and Nocardia. STUDY SELECTION AND DATA EXTRACTION: Prospective and retrospective studies, case reports, case series, and in vitro studies were eligible for inclusion if they used linezolid for nocardiosis regardless of site of infection and outcome. DATA SYNTHESIS: We identified 11 published cases of linezolid use for Nocardia spp. infections. The predominant species isolated were N. asteroides (n = 4; 36%) and N. farcinica (n = 3; 27%). Nocardiosis with central nervous system involvement (n = 7; 64%) or disseminated disease (n = 4; 36%) were most common. The main reason for discontinuation of previous antimicrobials was most often related to adverse effects (n = 5; 45%), followed by clinical failure (n = 3; 27%). Linezolid was associated with cure or improvement in all cases (n = 11; 100%). However, the majority of patients developed serious complications that may have led to premature discontinuation of therapy with linezolid, including myelosuppression (n = 5; 45%) or possible/confirmed peripheral neuropathy (n = 2; 18%). CONCLUSIONS: The limited published data suggest that linezolid appears to be an effective alternative to trimethoprim/sulfamethoxazole for the treatment of nocardiosis. Unfortunately, the high cost and potentially serious long-term toxicities of linezolid appear to limit its use and relegate it to salvage therapy alone or in combination with other antimicrobials.

Emerging therapies in the treatment of Clostridium difficile-associated disease.

OBJECTIVE: To describe emergent therapies, such as rifaximin, nitazoxanide, intravenous immunoglobulin (IVIG), tinidazole, tolevamer, and the possible use of a vaccine, in Clostridium difficile-associated disease (CDAD), one of the most common causes of diarrhea in hospitalized adults in North America. DATA SOURCES: A literature search was performed using MEDLINE (1996-October 2006), PubMed (1996-October 2006), abstracts from Infectious Diseases Society of America (September 2006) and International Conference on Antimicrobial Agents and Chemotherapy (September 2006), Internet (October 2006), Genzyme product Web site (October 2006), and Romark Laboratories Web site (October 2006) using the terms Clostridium difficile, rifaximin, nitazoxanide, intravenous immunoglobulin, tolevamer, vaccine, and tinidazole. STUDY SELECTION AND DATA EXTRACTION: Data presented in this article were selected based on clinical relevance and power of the studies. In vivo and in vitro studies supporting the use of drugs available for treatment of refractory CDAD were reviewed. Some of the information on new and emerging modalities was also included, although there were limited published data available. DATA SYNTHESIS: Clinical trials evaluating the use of nitazoxanide and tolevamer for the treatment of CDAD have been published. Tinidazole use is based on structural similarities to metronidazole; however, clinical trials have not been conducted and the cost of this agent may be a limiting factor. The use of rifaximin and IVIG will require randomized clinical trials to establish their place in therapy. Limited information in the literature suggests that a vaccine may be effective for CDAD prevention. CONCLUSIONS: CDAD is a debilitating disease with increasing treatment failure rates and recurrences using standard therapies. Clinicians need to look at other options to expand the available treatment arsenal in addition to placing a greater emphasis on prevention.