Application and clinical efficacy of ultrasound debridement method in residual burn wounds

He Zeliang; Li Jin; Sui Zhenyang; Zhang Julei; An Liang'en; Liu Lingling; Zhang Chengliang; Yao Yuanyuan; Qiu Shulin; Li Xiaodong

doi:10.3760/cma.j.cn501120-20211123-00396

Volume 38 Issue 11

Nov. 2022

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Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2022 > 38(11): 1034-1039

He ZL,Li J,Sui ZY,et al.Application and clinical efficacy of ultrasound debridement method in residual burn wounds[J].Chin J Burns Wounds,2022,38(11):1034-1039.DOI: 10.3760/cma.j.cn501120-20211123-00396.

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Application and clinical efficacy of ultrasound debridement method in residual burn wounds

doi: 10.3760/cma.j.cn501120-20211123-00396

Department of Burn and Plastic Surgery, the 980th Hospital of the Joint Logistic Support Force of PLA, Shijiazhuang 050091, China

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Medical Science Research Project of Hebei Province of China 20211620

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Corresponding author: Li Xiaodong, Email: 13933168616@163.com
Received Date: 2021-11-23

Abstract

Abstract

Objective To investigate the application and clinical efficacy of ultrasound debridement method in residual burn wounds. Methods A retrospective cohort study was conducted. From August 2017 to August 2021, 64 patients with residual burn wounds who met the inclusion criteria were admitted to the 980^th Hospital of the Joint Logistic Support Force of PLA. According to the debridement method adopted for the residual wounds, the patients were divided into ultrasound debridement group (34 cases, 22 males and 12 females, aged (31±13) years) and traditional debridement group (30 cases, 19 males and 11 females, aged (32±13) years). After the corresponding debridement, the wounds of patients in the two groups were selected for stamp skin grafting or large skin grafting according to the wound site and skin donor status. For unhealed wounds after stage Ⅰ surgery, secondary debridement and skin grafting were be performed, with the wound debridement methods in the 2 groups being the same as those of stage Ⅰ, respectively. On postoperative day 3, drug-sensitive test was used to detect the bacteria in the wound and the positive rate of bacteria was calculate. On postoperative day 7, the survival rate of skin slices in wound and the incidence of subcutaneous hematoma were calculated. At discharge, wound healing time and debridement times of patients were counted, and the secondary debridement rate was calculated. Data were statistically analyzed with independent sample t test or chi-square test. Results On postoperative day 3, the wounds in ultrasound debridement group were infected with Staphylococcus aureus in 2 cases and Pseudomonas aeruginosa in 2 cases, and the wounds in traditional debridement group were infected with Staphylococcus aureus in 5 cases, Pseudomonas aeruginosa in 3 cases, Acinetobacter baumannii in 1 cases, Klebsiella pneumoniae in 1 cases, and Enterobacter cloacae in 1 cases. The positive rate of bacteria of wound in ultrasound debridement group was significantly lower than that in traditional debridement group (χ²=5.51, P<0.05). On postoperative day 7, the survival rate of skin grafts in ultrasound debridement group was (92±5) %, which was significantly higher than (84±10) % in traditional debridement group (χ²=6.78, P<0.01); the incidence of subcutaneous hematoma in ultrasound debridement group was 17.6% (6/34), which was significantly lower than 40.0%( 12/30) in traditional debridement group, χ²=3.94, P<0.05. At discharge, the wound healing time in ultrasound debridement group was (11.0±2.0) d, which was significantly shorter than (13.0±3.1) d in traditional debridement group (t=3.81, P<0.01); the secondary debridement rate of wounds in ultrasound debridement group was 2.9% (1/34), which was significantly lower than 20.0% (6/30) in traditional debridement group (χ²=4.76, P<0.05). Conclusions Ultrasound debridement method can significantly reduce the bacterial load of residual burn wounds, reduce postoperative hematoma formation, and promote the survival of skin grafts to shorten the course of disease of patients.
- Burns,
- Infection,
- Debridement,
- Skin transplantation,
- Residual burn wounds

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References

[1]	TredgetEE, ShuppJW, SchneiderJC. Scar management following burn injury[J]. J Burn Care Res, 2017,38(3):146-147. DOI: 10.1097/BCR.0000000000000548.
[2]	吴军, 王玉振. 中国烧伤康复医学历程[J]. 中华烧伤杂志,2019,35(2):81-85. DOI: 10.3760/cma.j.issn.1009-2587.2019.02.001.
[3]	WangY, BeekmanJ, HewJ, et al. Burn injury: challenges and advances in burn wound healing, infection, pain and scarring[J]. Adv Drug Deliv Rev, 2018,123:3-17. DOI: 10.1016/j.addr.2017.09.018.
[4]	刘功成, 阚朝辉, 盛嘉隽, 等. 水动力清创系统在严重烧伤患者大面积残余创面清创中的应用效果[J].中华烧伤杂志,2016,32(9):549-554. DOI: 10.3760/cma.j.issn.1009-2587.2016.09.008.
[5]	CampitielloF, ManconeM, CorteAD, et al. An evaluation of an ultrasonic debridement method system in patients with diabetic foot ulcers: a case series[J]. J Wound Care, 2018,27(4):222-228. DOI: 10.12968/jowc.2018.27.4.222.
[6]	PalmieriB, VadalàM, LaurinoC. Electromedical devices in wound healing management: a narrative review[J]. J Wound Care, 2020,29(7):408-418. DOI: 10.12968/jowc.2020.29.7.408.
[7]	LianC, LiuH, LiuXJ, et al. Methylene blue staining and ultrasonic debridement method: a superior therapeutic strategy for pressure ulcer debridement[J]. Int J Low Extrem Wounds, 2021,20(1):73-74. DOI: 10.1177/1534734620980886.
[8]	LianC, LiuHL, LiYR, et al. Combination application of ultrasonic debridement method, methylene blue staining, and negative pressure wound therapy for severe pressure ulcers[J]. Int Wound J, 2020,17(1):232-233. DOI: 10.1111/iwj.13261.
[9]	WangM, XuX, LeiX, et al. Mesenchymal stem cell-based therapy for burn wound healing[J/OL]. Burns Trauma, 2021,9:tkab002[2021-11-23]. https://pubmed.ncbi.nlm.nih.gov/34212055/. DOI: 10.1093/burnst/tkab002.
[10]	ChenY, ZhangX, LiuZ, et al. Obstruction of the formation of granulation tissue leads to delayed wound healing after scald burn injury in mice[J/OL]. Burns Trauma, 2021,9:tkab004[2021-11-23]. https://pubmed.ncbi.nlm.nih.gov/34212057/. DOI: 10.1093/burnst/tkab004.
[11]	ChiY, YinH, ChenX, et al. Effect of precise partial scab removal on the repair of deep partial-thickness burn wounds in children: a retrospective study[J]. Transl Pediatr, 2021,10(11):3014-3022. DOI: 10.21037/tp-21-500.
[12]	BekaraF, VitseJ, FluieraruS, et al. New techniques for wound management: a systematic review of their role in the management of chronic wounds[J]. Arch Plast Surg, 2018,45(2):102-110. DOI: 10.5999/aps.2016.02019.
[13]	ThomasDC, TsuCL, NainRA, et al. The role of debridement in wound bed preparation in chronic wound: a narrative review[J]. Ann Med Surg (Lond), 2021,71:102876. DOI: 10.1016/j.amsu.2021.102876.
[14]	路遥, 杨润功, 朱加亮. 慢性创面清创技术的研究进展[J].中国修复重建外科杂志,2018,32(8):1096-1101. DOI: 10.7507/1002-1892.201801126.
[15]	GartenmannSJ, ThurnheerT, AttinT, et al. Influence of ultrasonic tip distance and orientation on biofilm removal[J]. Clin Oral Investig, 2017,21(4):1029-1036. DOI: 10.1007/s00784-016-1854-8.
[16]	VianaL, PompeoM. Healing rate of chronic and subacute lower extremity ulcers treated with contact ultrasound followed by noncontact ultrasound therapy: the VIP ultrasound protocol[J]. Wounds, 2017,29(8):231-239.
[17]	翟明翠, 刘锐, 井维斌, 等. 超声清创法治疗慢性创面的疗效观察[J/CD].中华损伤与修复杂志:电子版,2019,14(4):275-279. DOI: 10.3877/cma.j.issn.1673-9450.2019.04.007.
[18]	贾国璞, 刘晓丽, 高英杰, 等. 超声清创法联合重组人表皮生长因子治疗肛周脓肿合并感染的效果[J].中华医院感染学杂志,2021,31(3):424-428. DOI: 10.11816/cn.ni.2021-201378.
[19]	ZouQ, WangW, LiQ, et al. Effect of ultrasound debridement on serum inflammatory factors and bFGF, EGF expression in wound tissues[J]. J Coll Physicians Surg Pak, 2019,29(3):222-225. DOI: 10.29271/jcpsp.2019.03.222.
[20]	SteedDL. Clinical evaluation of recombinant human platelet-derived growth factor for the treatment of lower extremity ulcers[J]. Plast Reconstr Surg, 2006,117(7 Suppl):S143-149; discussion S150-151. DOI: 10.1097/01.prs.0000222526.21512.4c.
[21]	KataokaY, KunimitsuM, NakagamiG, et al. Effectiveness of ultrasonic debridement method on reduction of bacteria and biofilm in patients with chronic wounds: a scoping review[J]. Int Wound J, 2021,18(2):176-186. DOI: 10.1111/iwj.13509.
[22]	MirzaeiR, RanjbarR. Hijacking host components for bacterial biofilm formation: an advanced mechanism[J]. Int Immunopharmacol, 2022,103:108471. DOI: 10.1016/j.intimp.2021.108471.
[23]	da SilvaR, AfoninaI, KlineKA. Eradicating biofilm infections: an update on current and prospective approaches[J]. Curr Opin Microbiol, 2021,63:117-125. DOI: 10.1016/j.mib.2021.07.001.
[24]	HemmatiF, RezaeeMA, EbrahimzadehS, et al. Novel strategies to combat bacterial biofilms[J]. Mol Biotechnol, 2021,63(7):569-586. DOI: 10.1007/s12033-021-00325-8.
[25]	RuhalR, KatariaR. Biofilm patterns in gram-positive and gram-negative bacteria[J]. Microbiol Res, 2021,251:126829. DOI: 10.1016/j.micres.2021.126829.
[26]	SenCK, RoyS, Mathew-SteinerSS, et al. Biofilm management in wound care[J]. Plast Reconstr Surg, 2021,148(2):275e-288e. DOI: 10.1097/PRS.0000000000008142.
[27]	KamineniS, HuangC. The antibacterial effect of sonication and its potential medical application[J]. SICOT J, 2019,5:19. DOI: 10.1051/sicotj/2019017.
[28]	TewarieL, ChernigovN, GoetzenichA, et al. The effect of ultrasound-assisted debridement combined with vacuum pump therapy in deep sternal wound infections[J]. Ann Thorac Cardiovasc Surg, 2018,24(3):139-146. DOI: 10.5761/atcs.oa.17-00244.
[29]	Lázaro-MartínezJL, Álvaro-AfonsoFJ, García-ÁlvarezY, et al. Ultrasound-assisted debridement of neuroischaemic diabetic foot ulcers, clinical and microbiological effects: a case series[J]. J Wound Care, 2018,27(5):278-286. DOI: 10.12968/jowc.2018.27.5.278.
[30]	HuangG, ChenS, DaiC, et al. Effects of ultrasound on microbial growth and enzyme activity[J]. Ultrason Sonochem, 2017,37:144-149. DOI: 10.1016/j.ultsonch.2016.12.018.
[31]	MoriY, NakagamiG, KitamuraA, et al. Effectiveness of biofilm-based wound care system on wound healing in chronic wounds[J]. Wound Repair Regen, 2019,27(5):540-547. DOI: 10.1111/wrr.12738.
[32]	LaiJ, PittelkowMR. Physiological effects of ultrasound mist on fibroblasts[J]. Int J Dermatol, 2007,46(6):587-593. DOI: 10.1111/j.1365-4632.2007.02914.x.
[33]	MurphyCA, HoughtonP, BrandysT, et al. The effect of 22.5 kHz low-frequency contact ultrasound debridement (LFCUD) on lower extremity wound healing for a vascular surgery population: a randomised controlled trial[J]. Int Wound J, 2018,15(3):460-472. DOI: 10.1111/iwj.12887.
[34]	KavrosSJ, MillerJL, HannaSW. Treatment of ischemic wounds with noncontact, low-frequency ultrasound: the Mayo clinic experience, 2004-2006[J]. Adv Skin Wound Care, 2007,20(4):221-226. DOI: 10.1097/01.ASW.0000266660.88900.38.
[35]	尹会男, 柴家科, 李利根. 超声清创法系统结合负压创面疗法在骨外露创面中的应用[J/CD]. 中华损伤与修复杂志:电子版,2011,6(2):239-246.DOI: 10.3877/cma.j.issn.1673-9450.2011.02.012.
[36]	HagaM, InoueH, ShindoS. Treatment of prosthetic vascular graft infection in the groin with ultrasound debridement: a case report[J]. Ann Med Surg (Lond), 2020,60:68-71. DOI: 10.1016/j.amsu.2020.10.037.