MyMedR

Displaying publications 1 - 20 of 95 in total

Abstract:

Sort:

Fulltext Severe Orbital Myiasis Caused by Chrysomya bezziana: A Case Report

Ng YS, Gan YK, Tupang L

Turk J Ophthalmol, 2021 Feb 25;51(1):62-65.
PMID: 33631919 DOI: 10.4274/tjo.galenos.2020.00225

An 88-year-old woman was brought to the hospital immediately after her neighbours noticed that she was bleeding from her right eye. On examination, her right eye was phthisic with maggot infestation of her right orbit. Over a hundred live maggots were extracted using forceps. Computed tomography scan revealed the infestation was confined to the right orbit. The patient underwent exenteration of the right orbit under general anaesthesia. The species was identified by an entomologist as Chrysomya bezziana, which has aggressive larvae that eat living tissue. This case report demonstrates that orbital myiasis caused by C. bezziana poses a very real risk of intracranial invasion as they feed on living tissues. Adjacent tissue destruction can be very rapid and definitive treatment involves urgent removal of its larvae via surgical debridement. To our knowledge, we are reporting the first case of orbital myiasis from a patient in Malaysia. Therefore, our case report may be helpful in the management of similar case of orbital myiasis.

Matched MeSH terms: Debridement
Fulltext Crustacean Proteases and Their Application in Debridement

Perera E, Rodriguez-Viera L, Montero-Alejo V, Perdomo-Morales R

Trop Life Sci Res, 2020 Jul;31(2):187-209.
PMID: 32922675 DOI: 10.21315/tlsr2020.31.2.10

Digestive proteases from marine organisms have been poorly applied to biomedicine. Exceptions are trypsin and other digestive proteases from a few cold-adapted or temperate fish and crustacean species. These enzymes are more efficient than enzymes from microorganism and higher vertebrates that have been used traditionally. However, the biomedical potential of digestive proteases from warm environment species has received less research attention. This review aims to provide an overview of this unrealised biomedical potential, using the debridement application as a paradigm. Debridement is intended to remove nonviable, necrotic and contaminated tissue, as well as fibrin clots, and is a key step in wound treatment. We discuss the physiological role of enzymes in wound healing, the use of exogenous enzymes in debridement, and the limitations of cold-adapted enzymes such as their poor thermal stability. We show that digestive proteases from tropical crustaceans may have advantages over their cold-adapted counterparts for this and similar uses. Differences in thermal stability, auto-proteolytic stability, and susceptibility to proteinase inhibitors are discussed. Furthermore, it is proposed that the feeding behaviour of the source organism may direct the evaluation of enzymes for particular applications, as digestive proteases have evolved to fill a wide variety of feeding habitats, natural substrates, and environmental conditions. We encourage more research on the biomedical application of digestive enzymes from tropical marine crustaceans.

Matched MeSH terms: Debridement
Fulltext Scanning electron microscopic evaluation of the successful sterilization of Lucilia cuprina (Wiedemann) utilized in maggot debridement therapy (mdt)

Yeong YS, Nazni WA, Santana RL, Mohd Noor I, Lee HL, Mohd Sofian A

Trop Biomed, 2011 Aug;28(2):325-32.
PMID: 22041752

In Malaysia, maggot debridement therapy (MDT) utilizes maggots of Lucilia cuprina (Wiedemann) to debride necrotic tissue from wound surface, reduce bacterial infection and therefore, enhance wound healing process. To evaluate the sterility of the sterile maggots produced after sterilization process before delivering onto patient wounds. Sterility of sterile maggots is crucial in ensuring the safe usage of MDT and patient's health. Eggs of L. cuprina collected from a laboratory colony were divided into treated group (sterilized) and control group (non-sterilized). Treated group underwent sterilization while eggs from control group were allowed to hatch without sterilization. Sodium hypochlorite and formaldehyde were the main disinfectants used in this sterilization process. Scanning electron microscope (SEM) was used to examine and ascertain the sterility of sterile maggots. SEM results showed that all sterilized L. cuprina eggs and maggots achieved sterility and all were cleared from bacterial contamination. In contrast, all non-sterilized eggs and maggots were found to be colonized by microorganisms. Sterilization method employed to sterilize eggs and maggots used in Malaysia MDT was proven successful and MDT is safe to be used as wound management tools.

Matched MeSH terms: Debridement/methods
Diabetic Hand Infection: An Emerging Challenge

Bahar Moni AS, Hoque M, Mollah RA, Ivy RS, Mujib I

J Hand Surg Asian Pac Vol, 2019 Sep;24(3):317-322.
PMID: 31438802 DOI: 10.1142/S2424835519500401

Background: Hand infection in diabetics is an often ignored but challenging condition. If not addressed effectively, it may result in long term disability, contracture, amputation and even death. Methods: From August 2014 to December 2015, a study was done in our centre, where 49 diabetic hand infection cases were analyzed in two groups, superficial and deep hand infection. Results: Mean age of the patients was 51.63 years. There were 21 superficial infections and 28 deep infections. Cause of infection was unknown or spontaneous in 16 cases, traumatic laceration or crush in 14 patients, following minor prick in 10 cases. Most of the cases were the results of neglected minor wound. Forty-one patients were insulin dependent. Five cases were diagnosed as diabetic at the time of treatment. Four patients were treated conservatively and 45 (92%) cases required operation in the form of incision, drainage and debridement. In 16 (35%) cases, wound was left open and was healed by secondary intention following regular dressing. In five patients, wound was closed secondarily. Partial thickness skin graft was applied in 15 cases. Seven patients were treated with flap coverage. Partial digital or ray amputation were done in 16 cases. All fingers except thumb were amputated in one case and amputation from wrist was done in another patient. Wound swabs were taken, and antibiotics were changed or continued accordingly. But reports of 26 cases were available. No growth was found in four cases, monomicrobial infection was found in 15 patients and polymicrobial in seven cases. Infection resolved with healing in 47 cases. Two patients died during treatment from sepsis, both were insulin dependent, had associated renal failure and from deep infection group. One patient developed severe mental disorder. Conclusions: For diabetic hand infection, early diagnosis and prompt treatment with appropriate antibiotics and emergency surgery with extensile incision is crucial. Primary amputation of the part could be life and limb saving.

Matched MeSH terms: Debridement
Maggot Debridement Therapy in Malaysia

Nair HKR, Wasi Ahmad N, Teh CH, Lee HL, Chong SSY

Int J Low Extrem Wounds, 2021 Sep;20(3):208-216.
PMID: 32524879 DOI: 10.1177/1534734620932397

Maggot therapy, also known as maggot debridement therapy, larval therapy, biodebridement, or biosurgery, is a type of biotherapy involving the intentional application of live, disinfected fly larvae or maggots into the nonhealing wound of a human or animal to debride the necrotic wound, reduce bacterial contamination of the wound as well as enhance the formation of healthy granulation tissue and stimulate healing in nonhealing wounds. In addition, van der Plas et al reported that the use of the medicinal larvae as natural remover of necrotic and infected tissue had prevented amputation in 11 selected patients. In Malaysia, Aaron et al had demonstrated prevention of amputation in 25 patients.

Matched MeSH terms: Debridement
The Use of Engineered Bilayered Skin (MyDermTM) in the Management of Massive Skin Defect in Grade III Gustilo-Anderson Open Fracture

Mohamed Haflah NH, Ng MH, Mohd Yunus MH, Naicker AS, Htwe O, Fahmi M, et al.

Int J Low Extrem Wounds, 2017 Sep;16(3):212-216.
PMID: 28862056 DOI: 10.1177/1534734617724974

Open fracture Gustilo-Anderson grade IIIC is associated with higher risk of infection and problems with soft tissue coverage. Various methods have been used for soft tissue coverage in open fractures with large skin defect. We report a case of a patient who had grade IIIC open fracture of the tibia with posterior tibial artery injury. The patient underwent external fixation and reduction. Because of potential compartment syndrome after vascular repair, fasciotomy of the posterior compartment was performed. This wound, however, became infected and because of further debridement, gave rise to a large skin defect. A tissue engineered skin construct, MyDermTM was employed to cover this large defect. Complete wound closure was achieved 35 days postimplantation. The patient then underwent plating of the tibia for nonunion with no adverse effect to the grafted site. The tibia eventually healed 5 months postplating, and the cosmetic appearance of the newly formed skin was satisfactory.

Matched MeSH terms: Debridement/methods
Fulltext Tuberculous cold abscess of sternoclavicular joint: a case report

Burud I, Ikram MA, Tata MD, Jaafar J

Pan Afr Med J, 2020;36:16.
PMID: 32774593 DOI: 10.11604/pamj.2020.36.16.20697

Bone and joint tuberculosis is a serious medical problem; tuberculosis of sternoclavicular joint is rare. We present a case of a healthy 37-year old man with sternoclavicular joint tuberculosis. The subject presented with a three weeks history of left sternoclavicular joint painless swelling without fever or weight loss. He had no previous history of pulmonary tuberculosis. Laboratory testing revealed erythrocyte sedimentation rate of 70 mm/hour, C-reactive protein of 30 mg/liter and a normal leucocyte count. Biopsy of the lesion showed caseous necrosis and pus culture revealed Mycobacterium tuberculosis. He was treated with joint debridement and anti-tuberculous medications. Tuberculosis resolved completely but post-infection patients had residual joint arthritis. Tuberculosis may infect unusual joints such as the sternoclavicular joint.

Matched MeSH terms: Debridement
Fulltext Topical insulin for healing of diabetic epithelial defects?: A retrospective review of corneal debridement during vitreoretinal surgery in Malaysian patients

Bastion ML, Ling KP

Med J Malaysia, 2013 Jun;68(3):208-16.
PMID: 23749008 MyJurnal

PURPOSE: To investigate whether topical insulin improves healing rate of corneal epithelial erosions induced during vitreoretinal surgery in diabetics.
METHODS: We retrospectively reviewed case notes and serial post-operative photographs of 15 eyes of 14 patients who had corneal epithelial debridement performed during various vitreoretinal surgeries to improve one surgeon's view over a 10 month period in 2010.
RESULTS: Three groups were identified: DTI, comprising diabetics who received topical insulin 1 unit qds postoperatively (n=5); DCT comprising diabetics treated with conventional post-operative medications only (n=5) and NDCT comprising non diabetic patients on conventional post operative therapy (n=5). Only eyes in which the corneal epithelial defect had been serially photographed at time, t= 0, 12, 24, 36, 48, 60, 72 and 120 hours following commencement of topical medications were included. The size of the defect was calculated using local software. DTI eyes had a significantly smaller defect size at t= 24 (p=0.009), 36 (p=0.009), 48 (p=0.015) and 60 hours (p=0.005) compared to DCT eyes and had no statistical difference from NDCT eyes at all times in the Mann Whitney U analysis (p>0.05). In the diabetic operated bilaterally, the insulin treated eye re-epithelialised by 48 hours whereas fellow eye treated conventionally re-epithelialised in 72 hours.
CONCLUSIONS: Topical insulin or insulin eye drops 1 unit qds may be applied to the corneal surface to normalize the rate of healing of epithelial defects in diabetic patients undergoing epithelial debridement to improve the surgeon's view.

Matched MeSH terms: Debridement*
Fulltext Necrotizing fasciitis of the lower limb: an outcome study of surgical treatment

Kwan MK, Saw A, Chee EK, Lee CS, Lim CH, Zulkifle NA, et al.

Med J Malaysia, 2006 Feb;61 Suppl A:17-20.
PMID: 17042223

Necrotizing fasciitis is a limb- and life-threatening rapidly spreading infection affecting the deep fascia with secondary necrosis of the subcutaneous tissue. It requires immediate medical attention and emergency surgery to prevent morbidity and death. This study was undertaken to determine its co-morbidity and risk factors affecting the outcome of its surgical treatment. This is a retrospective review of 36 cases of necrotizing fasciitis of the lower limb treated in our center between 1998 and 2002. Only 19% of the cases were correctly diagnosed upon admission and 48.6% were initially diagnosed as 'cellulitis'. Diabetes mellitus was the most common co-morbid. Pseudomonas, Staphylococcus, Streptococcus and Enterobactericae were the common pathogens isolated. Ten patients (27.8%) had major amputation as part of radical debridement. The overall mortality rate was 36% with laboratory parameters: high serum urea and creatinine, and low haemoglobin levels were predictors for higher mortality. Poor white cell response which is common in diabetic patients and a delay in surgical debridement were. notable attributes to a higher mortality. Necrotizing fasciitis is a serious infection associated with significant morbidity and mortality. A poor white blood cell response, high serum urea and creatinine, and low haemoglobin level were the predictors for mortality. Early diagnosis and prompt treatment are of paramount importance in the treatment of this infection.

Matched MeSH terms: Debridement
Fulltext Venous gas embolism following hydrogen peroxide irrigation during debridement of chronic osteomyelitis lesion

Shukrimi A, Aminudin CA, Azril MA, Hadi MR

Med J Malaysia, 2006 Feb;61 Suppl A:88-90.
PMID: 17042238

We report a case of a previously healthy 53-year-old man who developed an intra-operative catastrophic event occurring in association with the use of hydrogen peroxide for wound irrigation following surgical debridement of a chronic osteomyelitis lesion of the humerus. It is our intention to highlight this potentially fatal consequence of hydrogen peroxide irrigation as part of bone debridement procedure. This case will serve as a reminder to orthopaedic surgeons who frequently use hydrogen peroxide in their surgical practice.

Matched MeSH terms: Debridement/adverse effects*
Fulltext Rhino-orbito-cerebral mucormycosis: a treatment dilemma

Jeevanan J, Gendeh BS, Faridah HA, Vikneswaran T

Med J Malaysia, 2006 Mar;61(1):106-8.
PMID: 16708746 MyJurnal

A case of rhino-orbito-cerebral mucormycosis is presented showing its aggressive nature and progression of disease. The typical clinical features, neuroimaging and histological findings are highlighted in this report. Amphotericin B and surgical debridement remain the mainstay of treatment. However, associated co-morbidities need to be addressed.

Matched MeSH terms: Debridement*
Fulltext Close fracture complicated by acute haematogenous osteomyelitis

Baskaran S, Nahulan T, Kumar AS

Med J Malaysia, 2004 Dec;59 Suppl F:72-4.
PMID: 15941170

This is the first time we encountered a peculiar case of osteomyelitis complicating a closed fracture. The patient was a 38 year-old lady who presented just like any other patient with a closed fracture of the right femur. Intraoperatively we were surprised to find pus from the fracture site. This not only changed the surgical management but altered the subsequent outcome as well.

Matched MeSH terms: Debridement/methods
Fulltext Necrotizing fasciitis

Zubaidah AW, Lim VKE

Med J Malaysia, 1996 Mar;51(1):134-6.
PMID: 10967993

A 31-year-old Pakistani man was admitted to hospital after sustaining a Grade I compound fracture of the mid-shaft of the left tibia and fibula following a motor vehicle accident. He developed septicaemic shock, acute renal failure and Group A streptococcal necrotizing fasciitis of the left leg. The patient underwent an above knee amputation followed by disarticulation of the left hip with extensive debridement. He was treated with benzylpenicillin, vancomycin, inotropes and continuous haemodialysis and survived without further sequelae. Subsequently, skin grafting was done over the wound site. This case highlights the role of Group A streptococcus as a cause of this rare and life-threatening infection.

Matched MeSH terms: Debridement
Septic arthritis of temporomandibular joint

Azmi NS, Mohamad N, Razali NA, Zamli AKT, Sapiai NA

Med J Malaysia, 2021 03;76(2):264-266.
PMID: 33742643

Septic arthritis (SA) occurrence for temporomandibular joint (TMJ) is rare. Pain, fever, swelling or loss of TMJ function are the typical presentation. The more common diagnosis for these presentations is internal derangement, osteoarthritis and rheumatoid arthritis. Therefore, TMJ septic arthritis is a challenging diagnosis and at risk of delayed diagnosis. We present a case of TMJ septic arthritis in a 46 year old Malay female with underlying hypertension and hypercholestrolemia, which was diagnosed as internal derangement in the initial presentation. The initial radiograph was normal. Arthrocentesis procedure had temporarily relieved the symptoms before progressive facial swelling developed after a week. Contrast enhanced computed tomography (CECT) brain revealed left TMJ abscess formation with left condylar erosion. Patient subsequently improved after wound debridement, left condylectomy and antimicrobial therapy.

Matched MeSH terms: Debridement
A peculiar case of Morel-Lavelle lesion of upper limb

Ab Halim MAH, Rampal S, Devaraj NK, Badr IT

Med J Malaysia, 2020 09;75(5):594-596.
PMID: 32918435

Morel-Lavallee lesions (MLL) are post-traumatic, closed internal degloving injuries that can result in severe complications if not diagnosed early. It is conventionally seen in cases of the high energy injuries of the pelvis and lower limb. The accumulation of extravasated blood, secondary to fracture and soft tissue damage may cause internal degloving injury, skin necrosis, soft tissue damage and acute osteomyelitis. We report here the clinical and radiological features in a 32-year-old male referred from the emergency department of a tertiary hospital who had sustained high energy motor vehicle accident. On examination, there was a fluctuant, mobile, non-tender subcutaneous mass over the distal arm with suspicion of internal degloving injury. Plain radiographs showed no fractures. Ultrasound showed a fluid collection with the presence of septations and echogenic debris within the collection. Extravasation was noted between subcutaneous tissue layer and fascia at the posterolateral aspect of the arm. Wound debridement under general anaesthesia was carried out. Intraoperative findings reported a significant amount of thick serous fluid with necrotic debris. Unhealthy skin and fat layers were debrided. Underlying muscles were found to be healthy. The results of the intraoperative fluid culture and sensitivity showed no growth. Negative pressure vacuum dressing was carried out. After five cycles of vacuum dressing, the wound showed signs of healing with an improved range of motion of the elbow. Orthopaedic surgeons need to be vigilant of the possibility of MLL in the upper limb as a differential diagnosis in the management of high energy trauma.

Matched MeSH terms: Debridement
External Inflammatory Root Resorption in Mandibular First Molar: A Case Report

Nayak MT, Nayak A

Malays J Med Sci, 2015 Nov;22(6):63-66.
PMID: 28223888

External root resorption (ERR) is an irreversible loss of external tooth structure. Its etiology is multifactorial, but in many aspects remain unclear. Periapical inflammation sustained by infection can cause apical root resorption in permanent teeth. The infection may be asymptomatic for many years, although it is rarely misdiagnosed. Treatment of such lesions should include use of intracanal medicaments for complete debridement of the microbes. Here, we present a case of 21-year-old male patient who presented with external inflammatory root resorption.

Matched MeSH terms: Debridement
Fulltext Necrotizing fasciitis of the head and neck: surgical outcomes in three cases

Shaariyah MM, Marina MB, Mohd Razif MY, Mazita A, Primuharsa Putra SH

Malays J Med Sci, 2010 Apr;17(2):51-5.
PMID: 22135538 MyJurnal

Necrotizing fasciitis of the head and neck is a rare, rapidly progressive infection involving the skin, subcutaneous tissue and fascia. We report three cases of necrotizing fasciitis that differ in their presentation and outcome. The first case involves a patient who presented with progressively enlarging anterior neck swelling that was later complicated by dehydration and reduced consciousness. The second case is a patient with neck swelling and ipsilateral otorrhea. The third case concerns a patient with a buccal ulcer complicated by ipsilateral facial swelling. All of them underwent a fasciotomy with wound debridement with the addition of a cortical mastoidectomy in the second case. Two of these patients recovered well. Unfortunately, the third case succumbed to death due to airway compromise and septicaemia. We advocate the importance of eradicating the source of infection followed by frequent, meticulous wound dressing and strict blood sugar control to obtain better outcomes in managing necrotizing fasciitis of the head and neck. However, involvement of the airway carries a grave prognosis despite aggressive treatment.

Matched MeSH terms: Debridement
Fournier's Gangrene: A Case of Neglected Symptoms with Devastating Physical Loss

Singam P, Wei KT, Ruffey A, Lee J, Chou TG

Malays J Med Sci, 2012 Jul;19(3):81-4.
PMID: 23610554

Fournier's gangrene is a severe life-threatening infection involving the perianal area, perineum, and external genitalia. It demands prompt recognition, critical care therapy, surgical therapy, and a combination of antibiotics. The infection commonly spreads via the fascial planes and causes superficial vascular thrombosis within the Colles' fascia around the external genitalia. It can extend cephalad to involve the Scarpa's fascia and Camper's fascia in the abdominal wall. The treatment would include multiple debridements, which would result in disfiguring scars of the perineum and might lead to significant physical and psychological complications. We describe a case of a 58-years-old man presenting with Fournier's gangrene resulting from an infection of an impacted urethral stone. The patient previously had obstructive voiding symptoms for 1 month but chose to neglect them. The resultant infection was severe and caused penile and right testicular gangrene. He underwent multiple wound debridements, which included a total penectomy and right orchiectomy. Psychological and rehabilitative support was necessary for him to overcome his loss and disfigurement.

Matched MeSH terms: Debridement
Facial carbuncle - a new method of conservative surgical management plus irrigation with antibiotic-containing solution

Ngui LX, Wong LS, Shashi G, Abu Bakar MN

J Laryngol Otol, 2017 Sep;131(9):830-833.
PMID: 28412984 DOI: 10.1017/S0022215117000834

OBJECTIVE: This paper reports on a non-conventional method for the management of facial carbuncles, highlighting its superiority over conventional surgical treatment in terms of cosmetic outcome and shorter duration of wound healing.
BACKGROUND: The mainstay of treatment for carbuncles involves the early administration of antibiotics in combination with surgical intervention. The conventional saucerisation, or incision and drainage, under normal circumstances results in moderate to large wounds, which may need secondary surgery such as skin grafting, resulting in a longer duration of wound healing and jeopardising cosmetic outcome.
CASE REPORTS: The reported three cases presented with extensive carbuncles over the chin, face and lips region. In addition to early commencement of intravenous antibiotics, the pus was drained, with minimal incision and conservative wound debridement, with the aim of maximal skin conservation. This was followed by thrice-daily irrigation with antibiotic-containing solution for a minimum of 2 consecutive days. The wounds healed within two to four weeks, without major cosmetic compromise.
CONCLUSION: The new method showed superior cosmetic outcomes, with a shorter duration of wound healing. Conservative surgical management can be performed under regional anaesthesia, which may reduce morbidity and mortality; patients with facial carbuncles often have higher risks with general anaesthesia.

Matched MeSH terms: Debridement/methods*
Quantitative assessment of wound healing using high-frequency ultrasound image analysis

Mohafez H, Ahmad SA, Hadizadeh M, Moghimi S, Roohi SA, Marhaban MH, et al.

Skin Res Technol, 2018 Feb;24(1):45-53.
PMID: 28557064 DOI: 10.1111/srt.12388

PURPOSE: We aimed to develop a method for quantitative assessment of wound healing in ulcerated diabetic feet.
METHODS: High-frequency ultrasound (HFU) images of 30 wounds were acquired in a controlled environment on post-debridement days 7, 14, 21, and 28. Meaningful features portraying changes in structure and intensity of echoes during healing were extracted from the images, their relevance and discriminatory power being verified by analysis of variance. Relative analysis of tissue healing was conducted by developing a features-based healing function, optimised using the pattern-search method. Its performance was investigated through leave-one-out cross-validation technique and reconfirmed using principal component analysis.
RESULTS: The constructed healing function could depict tissue changes during healing with 87.8% accuracy. The first principal component derived from the extracted features demonstrated similar pattern to the constructed healing function, accounting for 86.3% of the data variance.
CONCLUSION: The developed wound analysis technique could be a viable tool in quantitative assessment of diabetic foot ulcers during healing.

Matched MeSH terms: Debridement

Filters

Please provide feedback to Administrator (afdal@afpm.org.my)

External Links