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Clinical Research
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Operative technique for debridement of pressure ulcers First Author: Jessica Schiffman Authors: Jessica Schiffman, Michael Golinko, MD, Anna Flattau, MD, Robert Rennert, Harold Brem, MD Sepsis is the principal reason for hospitalization of patients with pressure ulcers[1]. We hypothesize that proper operative technique removes nonviable tissue, and resolves sepsis. To test this hypothesis, we analyzed the surgical technique of 42 consecutive surgical debridements and the corresponding length of stay for those patients at our center. The procedures focused on the removal of infected, necrotic and scar tissue. We obtained tissue samples for culture and pathological analysis from underlying tissue that grossly appeared viable. When undermining was present, a wedged excision was made with the vertex extending distally from the wound edge to the deepest level of undermining. Sutures were used as necessary for hemostasis. Hemostasis was further achieved with a topical coagulation agent* and microfibrillar collagen. Wounds were dressed with 4 x 4 gauze and/or a polyurethane membrane coating**. The modes of anesthesia used included intravenous sedation, regional block and general anesthesia. For the patients analyzed the average discharge time was 4.4 days post-debridement. There was no post-operative mortality or unplanned return to the operating room. We conclude that proper surgical debridement of pressure ulcers is a safe procedure that may prevent sepsis and death. Randomized control trials are needed to validate the importance of this procedure in improving clinical outcomes. *Floseal and **Tegaderm |
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