PubMed · 13640968
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J O GOODSELL. 1959-04-25. Debridement is paramount.. https://doi.org/10.1001/jama.1959.03000340064017
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Infections in the spine can lead to a wide range of problems for both the patient and physician. There is perhaps no more devastating complication than the neurological consequences of a cauda equina syndrome due to spinal infection. A variety of organisms and origins can make diagnosis and treatment of spinal infection a difficult task. Both pyogenic and nonpyogenic organisms can cause vertebral involvement and can result in an epidural abscess with neurological compromise. Nonetheless, these two types of infections vary greatly in terms of associated patient demographics, clinical course, and treatments. The purpose of this paper was to review these types of infections and summarize treatment recommendations for this difficult condition.
Chronic wounds are long-term results of various diseases. Evaluation and therapy of the underlying disorder must be the first goal of a comprehensive wound care protocol. Treatment of local (i.e. wound infection, necrosis, or foreign body) or systemic (i.e. diabetes, immunosuppression, or patient compliance) disturbing factors is the second major step for appropriate wound care. The third major point is wound bed preparation (i.e. debridement, moist wound dressings, or VAC therapy), and wound stimulation. After appropriate wound bed preparation, wounds can be closed by plastic surgery or wound stimulation through various agents (i.e. protease inhibitors, growth factors, or tissue engineering).
Although a pressure ulcer is a potentially serious condition that always calls for treatment, only a small percentage of patients with pressure ulcers are candidates for surgery. The choice between conservative treatment and surgery for a pressure ulcer depends on a thorough evaluation of the ulcer, as well as the patient's physical and mental states. In general, superficial pressure ulcers (stages I and II) are likely to benefit from conservative treatment. Deep pressure ulcers (stages III and IV, often resulting from spinal cord injury) often require surgical intervention. The surgical techniques described in this essay include direct closure (which is rarely indicated), local and sensate flaps, and skin grafting. Skin transplantation and cutaneous and other thin flaps have more limited indications in pressure ulcer surgery. Thorough debridement before reconstruction, patient compliance, control of concomitant disease, professional postoperative support, and sufficient pressure relief are imperative for treatment success.