title: Effective method to remove wound bacteria: comparison of various debridement modalities in an in vivo porcine model.
abstract: BACKGROUND
  Debridement is one of the crucial steps for successful wound care. In addition to removing necrotic tissue, debridement has been shown to reduce wound-associated bacteria that delay healing. Using an in vivo porcine model, we compared the effects of various methods of debridement, including hydrosurgery and plasma-mediated bipolar radiofrequency ablation (PBRA), on bacterial removal and wound healing.
  
  
  METHODS
  One hundred thirty-five deep dermal wounds were inoculated with methicillin resistant Staphylococcus aureus (MRSA) and covered with a polyurethane dressing for 48 h to allow for biofilm formation. Wounds were then treated with either PBRA (at two settings), hydrosurgery, sharp debridement, or no debridement. Biopsies were collected for microbiology and histologic assessment on d 0, 2, 9, and 21 post-treatment.
  
  
  RESULTS
  All treatment groups showed a statistically significant reduction in MRSA counts relative to no debridement at all times points (P < 0.05). PBRA at a maximum setting had the lowest MRSA counts at all recovery times and, compared with all other treatment groups, a statistically significant difference was observed on d 21 (P < 0.05). No detrimental effects on the healing process were noted with any of the debridement methods.
  
  
  CONCLUSIONS
  While sharp debridement has been established as the traditional gold standard for rapid removal of necrotic, infected tissue, our results suggest that novel debridement modalities show clinical promise for the treatment of chronic ulcers and burn wounds, especially when bacteria are present.
authors.affiliation: Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
authors.forename: Aron G
authors.initials: AG
authors.lastname: Nusbaum
authors.forename: Joel
authors.initials: J
authors.lastname: Gil
authors.forename: Marian K
authors.initials: MK
authors.lastname: Rippy
authors.forename: Brian
authors.initials: B
authors.lastname: Warne
authors.forename: Jose
authors.initials: J
authors.lastname: Valdes
authors.forename: Abel
authors.initials: A
authors.lastname: Claro
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Davis
mesh_terms: D000818:Animals; D017115:Catheter Ablation / Q000379:methods*; D003646:Debridement / Q000379:methods*; D004195:Disease Models, Animal; D005260:Female; D005355:Fibrosis / Q000517:prevention & control; D006875:Hydrotherapy / Q000379:methods; D007962:Leukocytes / Q000166:cytology; D055624:Methicillin-Resistant Staphylococcus aureus / Q000254:growth & development*; D009336:Necrosis / Q000517:prevention & control; D013207:Staphylococcal Skin Infections / Q000473:pathology / Q000517:prevention & control*; D013552:Swine; D014945:Wound Healing; D014947:Wounds and Injuries / Q000382:microbiology* / Q000473:pathology / Q000601:surgery*