How Can Refractory Ulcers be Treated with Surgery?

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  • Motomura Hisashi
    Department of Plastic and Reconstructive Surgery, Osaka City University, Graduate School of Medicine
  • Deguchi Ayaka
    Department of Plastic and Reconstructive Surgery, Osaka City University, Graduate School of Medicine
  • Hatano Takaharu
    Department of Plastic and Reconstructive Surgery, Osaka City University, Graduate School of Medicine
  • Fujikawa Heishiro
    Department of Plastic and Reconstructive Surgery, Osaka City University, Graduate School of Medicine
  • Maeda Shusaku
    Department of Plastic and Reconstructive Surgery, Osaka City University, Graduate School of Medicine
  • Nobuyama Ayami
    Department of Plastic and Reconstructive Surgery, Osaka City University, Graduate School of Medicine

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Other Title
  • The Role of Wound Surgeons in Debridement

Description

Foot ulcers due to diabetes or/and arteriosclerosis obliterans frequently result in an intractable condition which is refractory to treatment. In order to overcome such a condition, establishing a treatment modality based on the tissue, infection/inflammation, moisture balance, and edge of wound (TIME) concept to clinically perform wound bed preparation (WBP), as advocated by Schulz, is important. Therefore, the following steps are essential: 1) control and treat the disease-causing chronic wounds and 2) evaluate the wounds as per the TIME concept and perform local treatment at the proper timing. The core of this treatment concept is considered to be debridement. Debridement is a procedure carried out to protect the surrounding tissue by cleaning the wound of infectious and necrotic tissues, and this is crucial for chronic foot diseases. Our current strategy consists of two steps: initial medical treatment and subsequent aggressive treatment of the lesion. Our method of performing maintenance debridement, using trafermin spray and aggressive conservative therapy using NPWT, makes TIME-based wound bed preparation possible. Proper debridement at the proper time contributes to the success of this treatment. In this paper, we report the essential factors for debridement and our methods of debridement.

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