Debridement: choices and challenges.

Debridement of nonviable tissue is crucial to optimal wound healing, which can be impaired unless all necrotic tissue, exudate, and metabolic wastes have been removed from the wound. Debridement methods are classified as sharp, mechanical, chemical, and autolytic. This article describes methods of debridement and their outcomes.

Commentaries on venous leg ulcers diagnostic and treatment draft guideline.

A guideline on venous leg ulcer diagnosis and treatment was developed by a research team from the University of Pennsylvania School of Medicine, Philadelphia, Pa., in collaboration with an inter-disciplinary panel of wound care clinicians. Working from a consensus statement based on a literature review, the authors developed preliminary algorithms, which were reviewed by a national advisory panel. The draft guideline was prepared, and the authors now seek national peer review to address whether it is clinically relevant, useful and represents current practice. The entire diagnostic draft guideline was published in the April issue of Ostomy/Wound Management; the entire treatment draft guideline in the May issue. After peer review and pilot testing, the guideline will be modified and validated in prospective clinical trials.

Healing of physical wounds.

The sequence of events in the process of wound healing follows a predictable pattern when all components to support the process are present. Healing cannot be accelerated beyond its normal time span; however, there are factors that may negatively influence the rate of wound healing. Among these are malnutrition, infection, trauma, and concomitant medical diagnoses. Nursing functions required when there is an infection complicating the healing process or when wounds have had a surgical repair are usually determined by the physician's plan of care. Correction of malnourished states, control of diabetes, and improvement of anemia and subsequent tissue perfusion contribute to optimal states for wound healing to occur. Independent nursing functions regarding wound management include vigilance, protection from intrinsic and extrinsic factors that may impede healing, and support of those factors that promote optimum environment for the healing to occur.

The silent brain infarct in carotid surgery.

The destructive potential of carotid artery disease is underestimated by the clinical classification that surveys only that part of the brain with clear somatic representation. Asymptomatic patients are found to have brain infarctions on CT scan for which there is no history or symptom. To assume "benign" behavior of a carotid lesion, a patient must be both asymptomatic and "asignomatic." Likewise, when the morbidity of carotid operations is reported, silent infarcts must somehow be taken into account. We investigated this "silent" disease in a prospective study of 100 carotid operations done on 91 patients over a 9-month period in our service. All patients had arch and four-vessel selective arteriography. Detailed neurologic examinations and CT scans were done before and after surgery. Of the 91 patients, 78 (86%) had a history of neurologic problems. Preoperative CT scans showed infarction in 21 patients, but only 57% of the infarctions correlated with symptoms and/or history. Among patients with a history of transient ischemic attack (TIA), 19% had an infarction seen on CT scan; however, among those patients who had lateralizing TIAs, the incidence of unsuspected infarction was higher (26%). Arteriography showed a lesion in all carotid systems supplying a symptomatic or infarcted hemisphere. Following 100 operations, four patients had neurologic abnormalities--two had transient hemianopsia and two had hemiparesis. CT scan showed a new infarct in all four patients as well as in eight other patients without neurologic findings; two of these silent postoperative infarctions were found in the hemisphere opposite the side of the operated carotid artery.(ABSTRACT TRUNCATED AT 250 WORDS)