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Fulltext Refractory Scedosporium apiospermum Keratitis Successfully Treated with Combination of Amphotericin B and Voriconazole

Fadzillah MT, Ishak SR, Ibrahim M

Case Rep Ophthalmol Med, 2013;2013:413953.
PMID: 23509650 DOI: 10.1155/2013/413953

Aim. To report a case of refractory fungal keratitis caused by Scedosporium apiospermum. Methods. Interventional case report. Results. A 47-year-old Malay housewife presented with left eye cornea ulcer as her first presentation of diabetes mellitus. There was no history of ocular trauma, contact lens used, or cornea foreign body. Scedosporium apiospermum was isolated from the cornea scrapping. Her cornea ulcer initially responded well to topical Amphotericin B within 3 days but subsequently worsened. Repeat cornea scrapping also yields Scedosporium apiospermum. This refractory keratitis was successfully treated with a combination of topical Amphotericin B and Voriconazole over 6 weeks. Conclusion. Scedosporium apiospermum keratitis is an opportunistic infection, which is difficult to treat despite tight control of diabetes mellitus and intensive antifungal treatment. The infection appeared to have very quick onset but needed long duration of treatment to completely heal. Surgical debridement always plays an important role as a therapeutic procedure as well as establishes the diagnosis through repeat scrapping.

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
Combined endoscopic transnasal and transoral approach for extensive upper cervical osteoradionecrosis

Tan SH, Ganesan D, Rusydi WZ, Chandran H, Prepageran N, Waran V

Eur Spine J, 2015 Dec;24(12):2776-80.
PMID: 26210311 DOI: 10.1007/s00586-015-4153-1

PURPOSE: Osteoradionecrosis (ORN) is a rare yet well-recognized complication following radiotherapy to the head and neck. We illustrate the only case of a spontaneous extrusion of the sequestered C1 arch through the oral cavity and discuss our experience with a combined endoscopic transnasal and transoral approach for cervical ORN.
METHODS: A 56-year-old female presented with a 3-month history of blood-stained nasal discharge. She had been treated with radiotherapy for nasopharyngeal carcinoma 25 years earlier. Flexible nasal endoscopy demonstrated an exposed bone with an edematous posterior nasopharyngeal mass. Computed tomography showed a pre-vertebral mass with destruction of C1 and C2. She underwent occipito-cervical fusion followed by a combined transnasal and transoral endoscopic debridement of non-viable bone in the same perioperative setting. Healing of the raw mucosa was by secondary intention and reconstruction was not performed.
RESULTS: Histopathological examination reported ulcerated inflamed granulation tissue with no evidence of malignancy. During follow-up, she remained neurologically intact with no recurrence.
CONCLUSION: Using both nasal and oral spaces allows placement of the endoscope in the nasal cavity and surgical instruments in the oral cavity without splitting the palate. Hence, the endoscopic transnasal and transoral approach has vast potential to be effective in carefully selected cases of cervical ORN.

Matched MeSH terms: Debridement/methods
Non-surgical management of an extraoral cutaneous sinus tract of odontogenic origin

Varghese LL, Bhattacharya A, Sharma P, Apratim A

BMJ Case Rep, 2020 Jul 20;13(7).
PMID: 32690568 DOI: 10.1136/bcr-2020-234699

Chronic apical periodontitis associated with dental pulp necrosis is the main cause of odontogenic extraoral cutaneous sinus openings. These tracts are often initially misdiagnosed unless the treating clinician considers a dental aetiology. This case report of a 19-year-old woman describes the diagnosis and treatment of an extraoral cutaneous sinus tract of odontogenic origin. Non-surgical conservative endodontic therapy was opted as the involved teeth were restorable. One month after the completion of obturation, there was closure of the sinus tract. One year follow-up showed complete resolution of the sinus tract with minimal scar formation.

Matched MeSH terms: Periodontal Debridement/methods*
Maggot debridement therapy with Lucilia cuprina: a comparison with conventional debridement in diabetic foot ulcers

Paul AG, Ahmad NW, Lee HL, Ariff AM, Saranum M, Naicker AS, et al.

Int Wound J, 2009 Feb;6(1):39-46.
PMID: 19291114 DOI: 10.1111/j.1742-481X.2008.00564.x

This is prospective case-control study of more than 18 months performed to assess the effectiveness of maggot debridement therapy (MDT) with the sterile larvae of Lucilia cuprina (a tropical blowfly maggot) for the treatment of diabetic foot ulcers. Literature thus far has only reported results with the temperate maggot, Lucilia sericata. This study documents outcome in diabetic foot wounds treated with maggot debridement versus those treated by conventional debridement alone. In this series of 29 patients treated with MDT, 14 wounds were healed, 11 were unhealed and 4 were classified under others. The control group treated by conventional debridement had 30 patients of which 18 wounds were healed, 11 unhealed and 1 classified under others. There was no significant difference in outcome between the two groups. The conclusion that can be made from this study is that MDT with L. cuprina is as effective as conventional debridement in the treatment of diabetic foot ulcers. It would be a feasible alternative to those at high risk for surgery or for those who refuse surgery.

Matched MeSH terms: Debridement/methods*
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
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*
Fulltext Perioperative challenges in managing a patient with COVID-19 undergoing debridement for massive scalp myiasis

Lo SY, Teah MK, Ho YZ, Yeap TB

BMJ Case Rep, 2021 Feb 05;14(2).
PMID: 33547110 DOI: 10.1136/bcr-2020-241189

A young man presented to our centre needing an urgent debridement of his postcraniotomy wound due to massive myiasis during the COVID-19 pandemic in October 2020. Prior to the surgery, his nasopharyngeal swab real-time PCR test result was unknown. One day later, it returned as SARS-CoV-2 positive. All healthcare workers who were involved in the patient management avoided cross infection as they wore appropriate personal protective equipment. This article depicts the importance of adequate preparations when handling potentially infectious patients and the perioperative issues associated with it.

Matched MeSH terms: Debridement/methods*
Efficacy of papain-based wound cleanser in promoting wound regeneration

Ajlia SA, Majid FA, Suvik A, Effendy MA, Nouri HS

Pak J Biol Sci, 2010 Jun 15;13(12):596-603.
PMID: 21061910

A new invention, papain-based wound cleanser is formulated by incorporating papain, a proteolytic enzyme extracted from Carica papaya into the formulation. This cleanser is invented to simplify the methods in wound management by combining wound cleansing and wound debridement using a single formulation. This study describes the preparation and preclinical study of papain-based wound cleanser in accelerating wound healing. In this study, papain-based wound cleanser was used to treat wound incision on Sprague-Dawley rats while distilled water and Betadine were used as negative and positive control. Twenty-seven clinically healthy white rats were randomly divided into three groups and treated accordingly until the 21st day post-incision. Wound reduction rates and histological analysis were obtained to asses the healing pattern. Rats treated with papain-based wound cleanser showed a progressive wound healing based on the wound reduction rates and histological analysis when compared with rats treated with distilled water and Betadine. Better collagen deposition and presence of skin organelles in rats treated with papain-based wound cleanser demonstrated its efficacy in promoting wound healing. In addition to its wound healing effect, papain-based wound cleanser is also integrated with antibacterial properties which make it a complete package for wound management. However, further studies should be carried out to ensure its safety for human usage.

Matched MeSH terms: Debridement/methods*
Fulltext Chronic osteomyelitis secondary to human bite: a case report

Tan W, Wazir N, Chiu C, Ko M

Malays Orthop J, 2012 Nov;6(3):40-1.
PMID: 25279055 MyJurnal DOI: 10.5704/MOJ.1207.003

We report a case of a human bite that was initially inadequately treated and progressed to chronic osteomyelitis, finally resulting in digital amputation. Human bites are seemingly innocuous, but if neglected, may lead to subsequent infection and morbidity. Persistence of symptoms should alert the practitioner to the possibility of infection extending to the soft tissue or bone. Bacteriological studies commonly yield mixed aerobic and anaerobic flora. Early debridement and antibiotic treatment may prevent development of severe soft tissue or bone infection.

Matched MeSH terms: Debridement
Fulltext Clinical Efficacy of Single Application Local Drug Delivery and Adjunctive Agents in Nonsurgical Periodontal Therapy: A Systematic Review and Network Meta-Analysis

Tan OL, Safii SH, Razali M

Pharmaceutics, 2020 Nov 12;12(11).
PMID: 33198248 DOI: 10.3390/pharmaceutics12111086

This review aimed to rank the clinical efficacy of commercially available single-application local drug delivery and adjunctive agents (LDAs) compared with subgingival mechanical debridement (SMD) in nonsurgical periodontal therapy (NSPT). Randomized controlled clinical trials that compared LDAs against SMD alone or with placebo in adults (aged at least 18 years) diagnosed with periodontitis with a minimum of 6 months follow-up were included. A frequentist approach to random-effects network meta-analysis was implemented. The efficacies of the LDAs measured by probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain were reported as mean difference (MD) with 95% confidence intervals (CIs). The treatments were ranked according to their P-score. Four network meta-analyses suggested that sulfonic/sulfuric acid gel (PPD MD -1.13 mm, 95% CI -1.74 to -0.53, P-score 0.91; CAL MD -1.09 mm, 95% CI -1.58 to -0.61, P-score 0.95) and doxycycline hyclate gel (PPD MD -0.90 mm, 95% CI -1.50 to -0.30, P-score 0.93; CAL MD -0.84 mm, 95% CI -1.40 to -0.28, P-score 0.92) were the most effective in reducing PPD and gaining CAL in split-mouth and parallel studies, respectively (moderate certainty of evidence). LDAs have differing efficacies, but they present with possible clinical significance over SMD alone in NSPT.

Matched MeSH terms: Debridement
Aggressive periodontitis with a history of orthodontic treatment

Gupta VV, Ramachandra SS

J Indian Soc Periodontol, 2019 8 2;23(4):371-376.
PMID: 31367137 DOI: 10.4103/jisp.jisp_654_18

This report presents a 29-year-old aggressive periodontitis patient from Morocco with a history of orthodontic treatment. Despite all the first molars showing advanced bone loss, the maxillary anterior teeth did not show any periodontal destruction. The scientific literature rarely reports cases of aggressive periodontitis without involving maxillary anterior teeth. The treatment provided includes extraction of hopeless tooth, removal of overhanging restoration, scaling, root debridement, and regenerative periodontal therapy. The discussion highlights the dilemma during diagnosis of the case as either "iatrogenic periodontitis due to orthodontic treatment" or "localized aggressive periodontitis." The age group of 15-35 years is the common age group for patients' seeking orthodontic treatment and the occurrence of aggressive periodontitis. Sound knowledge of periodontitis and identification of early signs of aggressive periodontitis through meticulous periodontal examination may help in earlier identification and minimalistic treatment. Education regarding periodontitis, especially aggressive periodontitis, is essential among orthodontists and general dentists. This case report aims to discuss the dilemma involved during diagnosis of localized aggressive periodontitis.

Matched MeSH terms: Debridement
The effectiveness of photodynamic and antibiotic gel therapy as an adjunct to mechanical debridement in the treatment of peri-implantitis among diabetic patients

Ahmed P, Bukhari IA, Albaijan R, Sheikh SA, Vohra F

Photodiagnosis Photodyn Ther, 2020 Dec;32:102077.
PMID: 33157330 DOI: 10.1016/j.pdpdt.2020.102077

AIM: The current clinical trial aimed to assess the effectiveness of adjunctive photodynamic therapy (aPDT) and adjunctive antibiotic gel therapy (aAGT) to treat peri-implantitis among patients with type 2 diabetes mellitus (T2DM).
METHODS: Selected T2DM participants with peri-implantitis were distributed into 3 groups: Group-1: received a single session of adjunctive (aPDT); Group-2: received a single session of adjunctive (aAGT) (metronidazole 400 mg and amoxicillin 500 mg); and Group-3: received MD alone. Clinical (probing depth [PD], bleeding on probing [BOP], and plaque scores [PS]) and radiographic (crestal bone loss [CBL]) peri-implant variables were recorded. Levels of interleukin (IL)-6 and tumor necrosis factor-alpha (TNF-α) were assessed after the collection of peri-implant sulcular fluid (PISF). All the evaluations were carried out at baseline, 3- and 6-months. The significance level was set to p < 0.05.
RESULTS: At 3-and 6-months of follow-up, all the three groups showed significant alleviation in PS (p < 0.05), BOP (p < 0.05), and PD (p < 0.05) when compared with the baseline. At baseline, no significant variation was observed in all clinical and radiographic peri-implant parameters among all three research groups. At 3-months follow-up, a considerable alleviation of in PS, BOP, PD, and CBL was noticeable in group-1 patients when compared with the baseline. At 6-months follow-up, a comparable difference was observed in BOP, PD, and CBL between group-1 and group-2. At baseline, no significant variation was observed in the PISF levels of IL-6 and TNF-α among all three research groups. At 3- and 6-months follow-up, a considerable alleviation of TNF-α and IL-6 levels was observed in group-1 and group-2 patients, respectively, when compared with the baseline.
CONCLUSION: The application of aPDT demonstrated improved clinical, radiographic, and immunological peri-implant parameters for the treatment of peri-implantitis among T2DM patients.

Matched MeSH terms: Debridement
Fulltext Unilateral rhino-orbital-cerebral mucormycosis with contralateral endogenous fungal endophthalmitis

Ho HC, Liew OH, Teh SS, Hanizasurana H, Ibrahim M, Shatriah I

Clin Ophthalmol, 2015;9:553-6.
PMID: 25848206 DOI: 10.2147/OPTH.S82204

Rhino-orbital-cerebral mucormycosis (ROCM) is an uncommon but fatal fungal infection. We report a rare case of unilateral ROCM with ipsilateral central retinal artery occlusion and contralateral choroiditis, which later progressed to endogenous fungal endophthalmitis. The patient was successfully treated with sinuses debridement, systemic liposomal amphotericin B, and intravitreal amphotericin B. The endophthalmitis completely resolved with good vision, but the ROCM eye remained blind due to central retinal artery occlusion.

Matched MeSH terms: Debridement
Fulltext An unusual case of chronic suppurative osteomyelitis of the mandible

Kamran Ali, Ashfaq Akram, Muhammad Usman Akhtar

Archives of Orofacial Sciences, 2012;7(1):1-5.
MyJurnal

Osteomyelitis of the mandible, a serious complication of untreated odontogenic infection has been reported. This case report describes an interesting presentation of chronic suppurative osteomyelitis (CSO) of the mandible in a 13 years old anaemic male patient. Investigations revealed inversion of his permanent teeth leading to trans-cutaneous extra-oral eruption along with marked destruction of mandible on the affected side. The treatment included a pre surgical course of antibiotics followed by the removal of the retained second premolar tooth, surgical debridement of the affected bone, and resection of the cutaneous sinus tract. The post-operative healing was uneventful. A combination of antibiotic therapy and surgical debridement were effective in the treatment of chronic suppurative osteomyelitis.

Matched MeSH terms: Debridement
Fulltext A Rare Infection Following Snakebite

Cheong, C.Y., Lee, C.K., Zuki Z.

Malays Orthop J, 2010;4(1):-.
MyJurnal

Snakebite is very common especially in Asia. We report a rare case of Providencia rettgeri infection following snakebite on the foot. This patient was treated with early and aggressive wound debridement, daily wound dressing during hospitalization and then skin coverage with split skin graft. No anti-venom was given administered. Appropriate intravenous antibiotics were given to the patient while hospitalized and oral antibiotic were prescribed upon discharge. The outcome of this treatment was successful.

Matched MeSH terms: Debridement
Fulltext The Use Of Demineralized Freeze-dried Bovine Bone Xenograft In Reducing Post-surgical Periodontal Recession

Baharuddin, N.A., Kamin, S., Samsuddin, A.R.

Ann Dent, 2005;12(1):-.
MyJurnal

The aim of this study was to determine the effectiveness of demineralized freeze-dried bone xenograft (DFDBBX) in minimizing post-surgical recession in moderate to advanced adult periodontitis in patients. Nine patients with a total of eighteen intrabony defects were matched for the tooth type, location of defects and periodontal pocket depth (5 to 7mm). Following an initial nonsurgical treatment, recession at defects indicated for surgery was measured pre-operatively. Surgical treatment was carried out by split mouth design, where the test sites were assigned DFDBBX and the control sites were subjected to debridement without the use of DFDBBX. Recessions were measured at 3 months, 6 months and 9 months post-operatively. The results showed no statistically significant difference in mean recession at 3, 6 and 9 months post-operatively compared to baseline for both test and control groups. Thus, DFDBBX was ineffective in minimizing recession on patients with moderate to severe periodontitis, as compared to surgical debridement alone.

Matched MeSH terms: Debridement
Fulltext The Use Demineralized Freeze-Dried Bovine Bone Xenograft In Reducing Post-Surgical Periodontal Pocket Depth

Baharuddin, N.A., Kamin, S., Samsuddin, A.R.

Ann Dent, 2003;10(1):-.
MyJurnal

This study evaluated the effectiveness of demineralized freeze-dried bone xenograft in reducing post-surgical pocket depth in moderate to advanced adult periodontitis in patients. Nine patients with a total of eighteen intrabony defects were selected for this study. The bony defects were matched for tooth type, location and pocket depth. Following an initial non-surgical treatment, only pockets of 5 to 7 mm deep were indicated for surgery. Periodontal pockets were measured pre-operatively and at 3, 6 and 9 months post-surgically. The study protocol included a split mouth design, where surgical treatment was carried out at both test and control sites. The test sites were assigned demineralized freeze-dried bone xenograft and the control sites were subjected to debridement alone without the use of demineralized freeze-dried bone xenograft. The results from this study showed a statistically significant difference in the mean pocket depth at 6 and 9 months post-operatively for both test and control groups, but there was no statistically significant difference at 3 months. In conclusion, demineralized freeze-dried bone xenograft was ineffective in reducing periodontal pocket depth in patients with moderate to severe periodontitis, as compared to surgical debridement alone.

Matched MeSH terms: Debridement
Fulltext Stage protocol in the management of infection following plating of the Tibia

Nazri, M.Y.

International Medical Journal Malaysia, 2012;11(1):41-46.
MyJurnal

Introduction: Anterior border of the tibia is covered only by a thin layer of protective tissue. Plating of the tibia often results in wound complication and infection if the injury to this area is not recognized. We review our results of managing infection following plating of the tibia using a protocol base on the status of bone healing and the presence of bone or soft-tissue defect. Methods: Eight cases of infection following plating of the tibia were managed according to stage procedures protocols and classification, which is based on the state of bony union and the defect following wound debridement. The soft-tissue defects were managed with local flaps, and the bone defects were managed with Illizarov bone transport. Results: Three patients had more than one bacterium isolated. Gram negative organisms were isolated from seven patients. Methicillineresistant Staphylococcus aureus was isolated in two patients. All patients achieved union with a mean union
time of seven months. The infections were controlled in seven patients. One patient had minimal sinus discharge but refused further treatment. Conclusions: The stage protocol for the management of infection following plating of the tibia is practical and produces excellent results.

Matched MeSH terms: Debridement
Osteomyelitis in childhood -the natural history documented by radiographs

Singh, H.

Malaysian Journal of Paediatrics and Child Health, 2000;12(1):74-76.
MyJurnal

It is very rare indeed in the practice of children's orthopaedics today in Malaysia that the natural history of long bone osteomyelitis is seen. A case is presented where a shoulder abscess in a 3-year-old child developed into septic arthritis of the shoulder and subsequently chronic osteomyelitis of the adjacent humerus. The parents refused active surgical debridement and sequestrectomies. Three years later the child had regenerated a new humerus over the sequestra. Radiographs are presented illustrating the entire natural history of osteomyelitis with the regeneration of a new humerus.

Matched MeSH terms: Debridement

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