Burn Wound Bacteriological Profiles, Patient Outcomes, and Tangential Excision Timing: A Prospective, Observational Study.

PURPOSE: Because infection can thwart burn healing, microorganisms, their susceptibility patterns, and the effect of tangential excision timing on outcomes of burn patients were examined. METHODS: A prospective, observational study was conducted that involved 318 patients with deep second-degree burns from a gas explosion treated in Xinxiang, Henan, China between January 2009 and December 2016. Patient demographic data, culture and antimicrobial susceptibility test results, and outcome variables (resuscitation fluid volume, signs of shock, body temperature, heart rate, and time to wound healing) were analyzed. Outcomes were compared among patients who had early (<24 hours), middle (2 to 7 days), and late (> 7 days) post burn excision. RESULTS: Bacterial culture and drug sensitivity data were available for 314 of the 318 persons with burns >10% of total body surface area (TBSA). Of the 486 bacterial isolates, 330 (67.9%) were gram-negative and 156 (32.1%) were gram-positive. The number of isolates and resistance to third-generation cephalosporins increased over time. Patients having early tangential excision had significantly lower heart rate (P <.05) and reduced time to healing (P <.01) than patients in the middle or late excision group. CONCLUSION: Early tangential excision was found to be safe and to facilitate healing.

Historical origins and current concepts of wound debridement.

In the late 18th Century wound debridement consisted of incision of skin and deep fascia to release the swelling associated with ballistic injury, however extremity war wounds were more usually managed non-operatively or by amputation. During the First World War debridement was redefined to include excision of all non-viable and foreign material. In the modern era it has been proposed that wounds contain a zone of injured tissue which is not obviously non-viable at the initial debridement. Debridement which preserves this tissue has been described as marginal debridement. Wounds sustained in close proximity to explosions have an extensive zone of injury. Preservation of traumatised tissue may be beneficial in terms of limb salvage and limb reconstruction. Equally the complexity and contamination of these wounds, as well as the physiological frailty of the casualty, may make complete debridement in one sitting an unachievable goal. Where traumatised tissue has been left during debridement it must be reassessed at around 48 hours in order to reduce the risk of infection. Evacuation timelines and logistic infrastructure currently support serial marginal debridement but in future conflicts this may not be the case.

Determination of problematic ICD-9-CM subcategories for further study of coding performance: Delphi method.

In this study, we report on a qualitative method known as the Delphi method, used in the first part of a research study for improving the accuracy and reliability of ICD-9-CM coding. A panel of independent coding experts interacted methodically to determine that the three criteria to identify a problematic ICD-9-CM subcategory for further study were cost, volume, and level of coding confusion caused. The Medicare Provider Analysis and Review (MEDPAR) 2007 fiscal year data set as well as suggestions from the experts were used to identify coding subcategories based on cost and volume data. Next, the panelists performed two rounds of independent ranking before identifying Excisional Debridement as the subcategory that causes the most confusion among coders. As a result, they recommended it for further study aimed at improving coding accuracy and variation. This framework can be adopted at different levels for similar studies in need of a schema for determining problematic subcategories of code sets.

Medical devices; general and plastic surgery devices; classification of the low energy ultrasound wound cleaner. Final rule.

The Food and Drug Administration (FDA) is classifying the low energy ultrasound wound cleaner into class II (special controls). The special control that will apply to the device is the guidance document entitled "Class II Special Controls Guidance Document: Low Energy Ultrasound Wound Cleaner." The agency is taking this action in response to a petition submitted under the Federal Food, Drug, and Cosmetic Act (the act) as amended by the Medical Device Amendments of 1976, the Safe Medical Devices Act of 1990, and the Food and Drug Administration Modernization Act of 1997 (FDAMA). The agency is classifying this device into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of the device. Elsewhere in this issue of the Federal Register, FDA is announcing the availability of the guidance document that will serve as the special control for the class II device.

Desbridamiento de úlceras por presión y otras heridas crónicas / Debridement of pressure ulcers and other chronic wounds

No disponible

Coding and reimbursement of primary care debridement and excision procedures.

Current medical practice requires physicians to accurately report services provided to patients. Patient billing for debridement and excision procedures involves the selection of specific 1992 Physicians' Current Procedural Terminology codes. Although a site-specific surgical procedure code often yields higher reimbursement than a general procedure code, physicians should select the code that most accurately reflects the procedure performed. This review identifies the codes used to report destruction and excision procedures performed by primary care physicians. Included in this review are skin debridement, burn debridement, excision of benign and malignant lesions of the skin and subcutaneous tissue, cyst and ganglion excision, nail excision, anorectal lesion excision, shave, paring, and skin tag excision procedures, and foreign body removal. The Health Care Financing Administration's relative value units and one state's published Medicaid payment rates are included for each procedure code. Instructions are provided for selecting between multiple coding options when more than one code describes the service provided.