Debridement

CoUagenase specifically cataly2es the hydrolysis of coUagen, and is used in debridement of dermal ulcers and bums (191). It, like chymopapain, is also useful in the treatment of herniated lumbar disks (192,193). The rationale for coUagenase treatment in this instance is based on the preponderance of coUagen in herniated disk tissue, and the inabiUty of other en2ymes to dissolve coUagen (194). 

Deoxyribonuclease (DNAase), an enzyme that degrades deoxyribonucleic acid, has been used in patients with chronic bronchitis, and found to produce favorable responses presumably by degrading the DNA, contributed by cell nuclei, to inflammatory mucus (213). Lysozyme [9001 -63-2] hydrolyzes the mucopeptides of bacterial cell walls. Accordingly, it has been used as an antibacterial agent, usually in combination with standard antibiotics. Topical apphcations are also useful in the debridement of serious bums, cellulitis, and dermal ulceration. 

In 1998, the FDA approved fibrin sealant for three specific indications. These include hemostasis at the time of cardiac surgical operations [8] (Fig. 2) as well as at the time of operative procedures to treat splenic trauma. The application of the fibrin sealant which consists of normal biologic components in the body s clotting cascade creates a localized clot which further enhances inherent clotting ability. Although approved for these specific hemostatic indications only, fibrin sealant is useful as a hemostat in a wide variety of off-label clinical situations as well [9,10]. These include such applications as hemostasis for liver trauma or resection [11], vascular anastomoses [12], tonsillectomy [13], peripheral joint replacement [14], dental extractions [15], and bum debridement [16]. 

MA M9 M09.001 Bacterial collagenase (Vibrio-type) Potential agent for burn debridment... 

Antibiotics are appropriate for pancreatic necrosis, which can be infected initially or be susceptible to a secondary infection.21 Selected intravenous antibiotic regimens are shown in Table 20-2. If necrosis is confirmed, antibiotics are insufficient as sole therapy surgical debridement is necessary for cure. 

Brain abscesses are localized collections of pus within the cranium. These infections are difficult to treat due to the presence of walled-off infections in the brain tissue that are hard for some antibiotics to reach. In addition to appropriate antimicrobial therapy (a discussion of which is beyond the scope of this chapter), surgical debridement is often required as an adjunctive measure. Surgical debridement also may be required in the management of neurosurgical postoperative infections. 

Immediate surgical debridement and intravenous broad-spectrum antibiotics are key to reducing the mortality associated with necrotizing fasciitis. 

Abscess drainage and debrided tissue, if obtainable, can be cultured and will yield the causative organism(s) up to 90% of the time. 

After resuscitation and hemodynamic stabilization, prompt surgical intervention is key in the treatment of NF. Delayed operative debridement increases mortality.21 Some... 

Deep tissue specimens obtained during surgical irrigation and debridement should be sent for Gram stain, culture, and sensitivity.3 Imaging Studies... 

If GAS is identified as the sole causative organism from deep tissue culture, antimicrobial therapy can be narrowed to high-dose IV penicillin G plus clindamycin. Antibiotic therapy should be continued until further operative debridements are unnecessary, the patient displays substantial clinical improvement, and fevers have abated for at least 48 to 72 hours.3... 

The nonpharmacologic treatment of diabetic foot ulcers may include off-loading, chemical or surgical debridement of necrotic tissue, wound dressings, hyperbaric oxygen, vascular or orthopedic surgery, and the use of human skin equivalents.30... 

Pressure relief, adequate nutrition (high-protein diet), and surgical debridement or abscess drainage are the mainstays of nonpharmacologic treatment.38... 

The patient received 4 weeks of intravenous antimicrobial therapy following debridement. Due to clinical improvement, the physician contacts you for a recommendation for an oral antibiotic to complete a total of 6 weeks of therapy. 

Felson, David F. and Joseph Buckwalter, Debridement and Lavage for Osteoarthritis of the Knee , New EnglandJournal of Medicine 347 (2002) ... 

Enzymes Thrombolytic agents, digestive aids, debriding agents (i.e. cleansing of wounds)... 

Mucopolysaccharidosis I (MPS I) Mucopolysaccharidosis TV Debriding/anti-inflammatory agents Digestive aids... 

Papain is a cysteine protease isolated from the latex of the immature fruit and leaves of the plant Carica papaya. It consists of a single 23.4 kDa, 212 amino acid polypeptide, and the purified enzyme exhibits broad proteolytic activity. Although it can be used as a debriding agent, it is also used for a variety of other industrial processes, including meat tenderizing and for the clarification of beverages. 

Chymotrypsin has also been utilized to promote debridement, as well as the reduction of soft tissue inflammation. It is also used in some opthalmic procedures, particularly in facilitating cataract extraction. It is prepared by activation of its zymogen, chymotrypsinogen, which is extracted from bovine pancreatic tissue. 

Yet another proteolytic preparation used for debridement of wounds and skin ulcers consists of proteolytic enzymes derived from B. subtilis. The preparation displays broad proteolytic activity and is usually applied several times daily to the wound surface. 

Local debridement and appropriate footwear and foot care are important in the early treatment of foot lesions. Topical treatments may be beneficial in more advanced lesions. 

Early and aggressive surgical debridement of all necrotic tissue is essential. 

Necrotic tissue must be thoroughly debrided, with wound drainage and amputation as required. 

---