Surgery Excision of necrotic tissue. debridement.

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/11/16 12:16:15」(JST)

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Debridement /dɨˈbriːdmənt/^[1] is the medical removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue. Removal may be surgical, mechanical, chemical, autolytic (self-digestion), and by maggot therapy, where certain species of live maggots selectively eat only necrotic tissue.^[2]

In oral hygiene and dentistry, debridement refers to the removal of plaque and calculus that have accumulated on the teeth. Debridement in this case may be performed using ultrasonic instruments, which fracture the calculus, thereby facilitating its removal, as well as hand tools, including periodontal scaler and curettes, or through the use of chemicals such as hydrogen peroxide.

In podiatry practitioners such as chiropodists, podiatrists and foot health practitioners remove conditions such as calluses and verrucas.

Debridement is an important part of the healing process for burns and other serious wounds; it is also used for treating some kinds of snake and spider bites.

Sometimes the boundaries of the problem tissue may not be clearly defined. For example, when excising a tumor, there may be micrometastases along the edges of the tumor that are too small to be detected, and if not removed, could cause a relapse. In such circumstances, a surgeon may opt to debride a portion of the surrounding healthy tissue — as little as possible — to ensure that the tumor is completely removed.

Types of wound debridement

Autolytic debridement

Autolysis uses the body's own enzymes and moisture to re-hydrate, soften and finally liquefy hard eschar and slough. Autolytic debridement is selective; only necrotic tissue is liquefied. It is also virtually painless for the patient. Autolytic debridement can be achieved with the use of occlusive or semi-occlusive dressings which maintain wound fluid in contact with the necrotic tissue. Autolytic debridement can be achieved with hydrocolloids, hydrogels and transparent films. This method works best in stage III or IV wounds with light to moderate exudate.

Enzymatic debridement

Chemical enzymes are fast acting products that slough off necrotic tissue. These enzymes are derived from micro-organisms including clostridium, histolyticum, collagenase, varidase, papain, and Bromelian. Some of these enzymatic debriders are selective, while some are not. This method works best on any wound, especially well on burns, with a large amount of necrotic debris, or with eschar formation. However, the results are mixed and the effectiveness is variable. Therefore, this type of debridement is used sparingly, and is not a standard of care for burn treatments.^[3]

Mechanical debridement

When removal of tissue is necessary for the treatment of wounds, hydrotherapy which performs selective mechanical debridement can be used.^[4] Examples of this include directed wound irrigation and therapeutic irrigation with suction.^[4] Baths with whirlpool water flow should not be used to manage wounds because a whirlpool will not selectively target the tissue to be removed and can damage all tissue.^[4] Whirlpools also create an unwanted risk of bacterial infection, can damage fragile body tissue, and in the case of treating arms and legs, bring risk of complications from edema.^[4]

Allowing a dressing to proceed from moist to dry, then manually removing the dressing causes a form of non-selective debridement. This method works best on wounds with moderate amounts of necrotic debris (e.g. "dead tissue").

Surgical debridement

Sharp surgical debridement and laser debridement under anesthesia are the fastest methods of debridement. They are very selective, meaning that the person performing the debridement has complete control over which tissue is removed and which is left behind. Surgical debridement can be performed in the operating room or bedside, depending on the extent of the necrotic material. This method works best on wounds with a large amount of necrotic tissue in conjunction with infected tissue in the wound.

Maggot therapy

In maggot therapy, a number of small maggots are introduced to a wound in order to consume necrotic tissue, and do so far more precisely than is possible in a normal surgical operation. Larvae of the green bottle fly are used, which primarily feed on the necrotic (dead) tissue of the living host without attacking living tissue. Maggots can debride a wound in a day or two. The maggots derive nutrients through a process known as "extracorporeal digestion" by secreting a broad spectrum of proteolytic enzymes that liquefy necrotic tissue, and absorb the semi-liquid result within a few days. In an optimum wound environment maggots molt twice, increasing in length from 1–2 mm to 8–10 mm, and in girth, within a period of 3–4 days by ingesting necrotic tissue, leaving a clean wound free of necrotic tissue when they are removed. When they stay longer or too many are used, healthy tissue is removed as well.

References

^ "Merriam-Webster Dictionary". merriam-webster.com.
^ "debridement". merriam-webster.com. Retrieved 5 September 2013.
^ Langer, Vijay; Bhandari, P.S.; Rajagopalan, S.; Mukherjee, M.K. (April 2013). "Enzymatic debridement of large burn wounds with papain–urea: Is it safe?". Medical Journal Armed Forces India 69 (2): 144–150. doi:10.1016/j.mjafi.2012.09.001.
^ ^a ^b ^c ^d American Physical Therapy Association (15 September 2014), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation (American Physical Therapy Association), retrieved 15 September 2014

External links

Medicine portal

The short film A METHOD OF TEACHING COMBAT SURGERY (1958) is available for free download at the Internet Archive
Wound Care Information Network

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1. 膵デブリドマン pancreatic debridement
2. 被包された膵液貯留 walled off pancreatic fluid collections including pseudocysts
3. 被包された膵液貯留の内視鏡によるマネージメント：手技 endoscopic management of walled off pancreatic fluid collections techniques
4. 急性膵炎のマネージメント management of acute pancreatitis
5. 急性膵炎の重症度予測 predicting the severity of acute pancreatitis

English Journal

Hydrogen peroxide-assisted endoscopic necrosectomy for walled-off pancreatic necrosis: a dual center pilot experience.

Siddiqui AA1, Easler J, Strongin A, Slivka A, Kowalski TE, Muddana V, Chennat J, Baron TH, Loren DE, Papachristou GI.
Digestive diseases and sciences.Dig Dis Sci.2014 Mar;59(3):687-90. doi: 10.1007/s10620-013-2945-x. Epub 2013 Nov 27.
PMID 24282052

The role of routine fine-needle aspiration in the diagnosis of infected necrotizing pancreatitis.

van Baal MC1, Bollen TL2, Bakker OJ3, van Goor H4, Boermeester MA5, Dejong CH6, Gooszen HG1, van der Harst E7, van Eijck CH8, van Santvoort HC3, Besselink MG9; Dutch Pancreatitis Study Group.Author information 1Department of Operating Room/Evidence Based Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.2Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands.3Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.4Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.5Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.6Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.7Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands.8Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.9Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: m.g.besselink@amc.nl.AbstractBACKGROUND: Diagnosing infected necrotizing pancreatitis (INP) may be challenging. The aim of this study was to determine the added value of routine fine-needle aspiration (FNA) in addition to clinical and imaging signs of infection in patients who underwent intervention for suspected INP.
Surgery.Surgery.2014 Mar;155(3):442-8. doi: 10.1016/j.surg.2013.10.001. Epub 2013 Oct 12.
BACKGROUND: Diagnosing infected necrotizing pancreatitis (INP) may be challenging. The aim of this study was to determine the added value of routine fine-needle aspiration (FNA) in addition to clinical and imaging signs of infection in patients who underwent intervention for suspected INP.METHODS: W
PMID 24287142

Pancreatic necrosectomy using covered esophageal stents: a novel approach.

Sarkaria S1, Sethi A, Rondon C, Lieberman M, Srinivasan I, Weaver K, Turner BG, Sundararajan S, Berlin D, Gaidhane M, Rolshud D, Widmer J, Kahaleh M.Author information 1*Division of Gastroenterology and Hepatology ‡Department of Surgery §Intensive Care Unit, Weil Cornell Medical College, Cornell University †Division of Gastroenterology and Hepatology, Columbia University College of Physicians and Surgeons, New York, NY.AbstractBACKGROUND: Endoscopic necrosectomy for necrotizing pancreatitis has been increasingly used as an alternative to surgical or percutaneous interventions. The use of fully covered esophageal self-expandable metallic stents may provide a safer and more efficient route for internal drainage. The aim of this study was to evaluate the safety and efficacy of endoscopic treatment of pancreatic necrosis with these stents.
Journal of clinical gastroenterology.J Clin Gastroenterol.2014 Feb;48(2):145-52. doi: 10.1097/MCG.0b013e3182972219.
BACKGROUND: Endoscopic necrosectomy for necrotizing pancreatitis has been increasingly used as an alternative to surgical or percutaneous interventions. The use of fully covered esophageal self-expandable metallic stents may provide a safer and more efficient route for internal drainage. The aim of
PMID 23751853

Japanese Journal

膵仮性嚢胞に対するEndoscopic necrosectomyの実際

山本夏代,伊佐山浩通,小池和彦
日本消化器内視鏡学会雑誌 55(7), 2040-2049, 2013
内視鏡的ネクロゼクトミーは手技や機器の発達により普及しつつある治療法である．膵仮性嚢胞に感染を併発した膵膿瘍や，壊死性膵炎などに伴う壊死組織を伴う液体貯留の場合，内部に壊死物質が貯留しており，ドレナージのみでは嚢胞の消失や寛解が得られない場合が多く，これらの場合の症例に対し，低侵襲の内視鏡的ネクロゼクトミーの有用性の報告が見られている．本稿では具体的な手技について解説した．EUSガイド下に瘻孔を拡 …
NAID 130003375337

感染性膵壊死のnecrosectomyにおける，内視鏡的アプローチと手術的アプローチの無作為化比較試験

斎藤友隆,濱田毅,伊佐山浩通
日本消化器内視鏡学会雑誌 54(6), 1886-1886, 2012
NAID 130002052343

Studies of endoscopic ultrasound-guided drainage for pancreatic pseudocysts and abscesses: a university hospital-based experience

Kida Mitsuhiro,Miyazawa Shiro,Iwai Tomohisa [他]
The Kitasato medical journal 41(2), 170-177, 2011-09-00
NAID 40019009584

Related Pictures

Cases > Pancreatic Necrosectomy NECROSECTOMY – Of Saw and Syringe (DEMO) transgastric pancreatic necrosectomy

★リンクテーブル★

リンク元	「ネクロセクトミー」

「ネクロセクトミー」

Debridement
	Intervention
	Necrotic tissue from the left leg is being surgically debrided in a patient with necrotizing fasciitis.
ICD-10-PCS	0?D
MeSH	D003646

　　[★]

英: necrosectomy
関: [[]]

[1] "Merriam-Webster Dictionary". merriam-webster.com.

[2] "debridement". merriam-webster.com. Retrieved 5 September 2013.

[3] Langer, Vijay; Bhandari, P.S.; Rajagopalan, S.; Mukherjee, M.K. (April 2013). "Enzymatic debridement of large burn wounds with papain–urea: Is it safe?". Medical Journal Armed Forces India 69 (2): 144–150. doi:10.1016/j.mjafi.2012.09.001.

[APTAfive-4] American Physical Therapy Association (15 September 2014), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation (American Physical Therapy Association), retrieved 15 September 2014

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necrosectomy