Debridement 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. 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 callus, corns, verrucas etc. 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 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. Best uses In stage III or IV wounds with light to moderate exudate. Advantages Very selective, with no damage to surrounding skin. The process is safe, using the body's own defense mechanisms to clean the wound of necrotic debris. Effective, versatile and easy to perform Little to no pain for the patient Disadvantages Not as rapid as surgical debridement Wound must be monitored closely for signs of infection May promote growth of anaerobic organisms if an occlusive hydrocolloid is used Enzymatic debridement Chemical enzymes are fast acting products that produce slough of necrotic tissue. Some enzymatic debriders are selective, while some are not. Best uses On any wound with a large amount of necrotic debris. Eschar formation Advantages Fast acting Minimal or no damage to healthy tissue with proper application. Can be used in patients who are not eligible for surgical debridement. Disadvantages Expensive Requires a prescription Application must be performed carefully only to the necrotic tissue. May require a specific secondary dressing Inflammation or discomfort may occur

Mechanical debridement This technique has been used for decades in wound care. Allowing a dressing to proceed from moist to wet, then manually removing the dressing causes a form of non-selective debridement. Hydrotherapy is also a type of mechanical debridement. Its benefits versus risks are of issue. Best uses Wounds with moderate amounts of necrotic debris Advantages Cost of the actual material (ie. gauze) is low Disadvantages Non-selective and may traumatize healthy or healing tissue Time consuming Can be painful to patient Hydrotherapy can cause tissue maceration. Also, waterborne pathogens may cause contamination or infection. Disinfecting additives may be cytotoxic. 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 at bedside, depending on the extent of the necrotic material. Best uses Wounds with a large amount of necrotic tissue. In conjunction with infected tissue. Advantages Fast and selective Can be extremely effective Disadvantages Painful to patient Requires anaesthesia, if the wound is large Costly, especially if an operating room is required Requires transport of patient if operating room Surgical complications Not to be used in patient with compromised blood supply

Sebaceous cyst (Epidermal cyst; Keratin cyst; Epidermoid cyst) A sebaceous cyst is a closed sac under the skin filled with a cheese-like or oily material. Causes, incidence, and risk factors Sebaceous cysts most often arise from swollen hair follicles. Skin trauma can also induce a cyst to form. A sac of cells is created into which a protein called keratin is secreted. These cysts are usually found on the face, neck, and trunk. They are usually slow- growing, painless, freely movable lumps beneath the skin. Occasionally, however, a cyst will become inflamed and tender. Symptoms The main symptom is usually a small, non-painful lump beneath the skin. If the lump becomes infected or inflammed, other symptoms may include: Skin redness Tender or sore skin Warm skin in the affected area Grayish-white, cheesy, foul-smelling material may drain from the cyst. Signs and tests In most cases, your doctor can diagnose this type of cyst by simply examining your skin. Occasionally, a biopsy may be needed to rule out other conditions.

Treatment Sebaceous cysts are not dangerous and can usually be ignored. Placing a warm moist cloth (compress) over the area may help the cyst drain and heal. If you have a small inflamed cyst, your doctor may inject it with a steroid medicine that reduces swelling. If the cyst becomes swollen, tender, or large, your doctor may drain it or perform surgery to remove it. Expectations (prognosis) Large, painful cysts may interfere with day-to-day life. Complications These cysts may occasionally become infected and form painful abscesses. The cysts may return after they are surgically removed. Prevention There's no way to stop epidermoid cysts from forming, but avoiding excessive sun exposure and using oil-free skin care products can help prevent milia. To prevent scarring and infection, don't try to squeeze cysts yourself.

EGD esophagogastroduodenoscopy (Upper endoscopy; Gastroscopy) Esophagogastroduodenoscopy (EGD) is a test to examine the lining of the esophagus (the tube that connects your throat to your stomach), stomach, and first part of the small intestine. It is done with a small camera (flexible endoscope) which is inserted down the throat. How the Test is Performed You will be given a sedative and a painkiller (analgesic). You should feel no pain and not remember the procedure. A local anesthetic may be sprayed into your mouth to prevent you from coughing or gagging when the endoscope is inserted. A mouth guard will be inserted to protect your teeth and the endoscope. Dentures must be removed. In most cases, a needle (IV) will be inserted into a vein in your arm to give you medications during the procedure. You will be instructed to lie on your left side. After the sedatives have taken effect: The endoscope is inserted through the esophagus (food pipe) to the stomach and duodenum. Air is put into the endoscope to make it easier for the doctor to see. The lining of the esophagus, stomach, and upper duodenum is examined. Biopsies can be taken through the endoscope. Biopsies are tissue samples that are looked at under the microscope. Different treatments may be done, such as stretching or widening a narrowed area of the esophagus. After the test is finished, you will not be able to have foods and liquids until your gag reflex returns (so you don't choke). The test lasts about 5 to 20 minutes. How to Prepare for the Test You will not be able to eat anything for 6 to 12 hours before the test. You must sign an informed consent form. You may be told to stop taking aspirin and other blood-thinning medicines for several days before the test. How the Test Will Feel The local anesthetic makes swallowing difficult. This wears off shortly after the procedure. The endoscope may make you gag. You may feel gas, and the movement of the scope in your abdomen. You will not be able to feel the biopsy. Because of the sedation, you may not feel any discomfort and have no memory of the test. When you wake up, you may feel a little bloated from the air that was put into your body through the endoscope. This feeling will wear off in a short period of time. Why the Test is Performed EGD may be done if you have symptoms that are new, cannot be explained, or are not responding to treatment, such as: Black or tarry stools or vomiting blood Bringing food back up (regurgitation) Feeling full sooner than normal or after eating less than usual Feeling that food is stuck behind the breastbone Heartburn Low blood count (anemia) that cannot be explained Pain or discomfort in the upper abdomen Swallowing problems or pain with swallowing Weight loss that cannot be explained Nausea or vomiting that does not go away

Your doctor may also order this test if you: Have cirrhosis of the liver, to look for swollen veins (called varices) in the walls of the lower part of the esophagus, which may begin to bleed Have Crohn's disease Need more follow-up or treatment for a condition that has been diagnosed The test may also be used to take a piece of tissue for biopsy. Normal Results The esophagus, stomach, and duodenum should be smooth and of normal color. There should be no bleeding, growths, ulcers, or inflammation. What Abnormal Results Mean An abnormal EGD may be the result of: Celiac disease Esophageal rings Esophageal varices (swollen veins in the lining of the esophagus caused by liver cirrhosis) Esophagitis (when the lining of the esophagus becomes inflamed or swollen) Gastritis (when the lining of the stomach and duodenum becomes inflamed or swollen) Gastroesophageal reflux disease (a condition in which food or liquid from the stomach leaks backwards into the esophagus) Hiatal hernia (a condition in which part of the stomach sticks up into the chest through an opening in the diaphragm) Lower esophageal ring Mallory-Weiss syndrome (tear in the esophagus) Narrowing of the esophagus Tumors or cancer in the esophagus, stomach, or duodenum (first part of small intestine) Ulcers - gastric (stomach) or duodenal (small intestine) Risks There is a small chance of a hole (perforation) in the stomach, duodenum, or esophagus. There is also a small risk of bleeding at the biopsy site. You could have a reaction to the medicine used during the procedure, which could cause: Apnea (not breathing) Difficulty breathing (respiratory depression) Excessive sweating Low blood pressure (hypotension) Slow heartbeat (bradycardia) Spasm of the larynx (laryngospasm) The risk is less than 1 out of 1,000 people.

Total Abdominal Hysterectomy With and Without Bilateral Salpingo-oophorectomy Total abdominal hysterectomy is utilized for benign and malignant disease where removal of the internal genitalia is indicated. The operation can be performed with the preservation or removal of the ovaries on one or both sides. In benign disease, the possibility of bilateral and unilateral oophorectomy should be thoroughly discussed with the patient. Frequently, in malignant disease, no choice exists but to remove the tubes and ovaries, since they are frequent sites of micrometastases. In general, the modified Richardson technique of intrafascial hysterectomy is used. The purpose of the operation is to remove the uterus through the abdomen, with or without removing the tube and ovaries. Physiologic Changes. The predominant physiologic change from removal of the uterus is the elimination of the uterine disease and the menstrual flow. If the ovaries are removed with the specimen, the predominant physiologic change noted is loss of the ovarian steroid sex hormone production. Points of Caution. The predominant point of caution in performing abdominal hysterectomy is to ensure that there is no damage to the bladder, ureters, or rectosigmoid colon. Mobilization of the bladder with a combination of sharp and blunt dissection frees the bladder from the lower uterine segment and upper vagina. This reduces the incidence of damage to the bladder. By exercising extreme care in management of the uterine artery pedicle, the surgeon may minimize the risk of injury to the ureter. The same is true of the management of the cardinal and uetrosacral ligament pedicles. If the vaginal cuff is left open with the edges sutured, the incidence of postoperative pelvic abscess is dramatically reduced.