Download PDF
CC BY-NC 4.0 · Arch Plast Surg 2020; 47(03): 228-234
DOI: 10.5999/aps.2019.01641
Original Article

Subeschar culture using a punch instrument in unstageable wounds

Han Byul Jung 
Department of Plastic and Reconstructive Surgery, Daegu Catholic University School of Medicine, Daegu, Korea
,
Yong Jig Lee 
Department of Plastic and Reconstructive Surgery, Daegu Catholic University School of Medicine, Daegu, Korea
› Author Affiliations
› Further Information
   Permissions and Reprints

Background A patient’s overall condition sometimes does not allow for the complete removal of a dead eschar or injured slough in cases involving a pressure-injury skin lesion. This frequently occurs in clinical practice, particularly in bedridden and older patients receiving home care or intensive care. Even after debridement, it is also difficult to manage open exudative wounds in these patients. Nevertheless, when a mature or immature eschar is treated without proper debridement, liquefaction necrosis underneath the eschar or slough tends to reveal a large, open wound with infectious exudates. We hypothesized that if the presence of any bacteria under the eschar can be evaluated and the progression of the presumed infection of the subeschar can be halted or delayed without creating an open wound, the final wound can be small, shallow, and uninfected.

Methods Using a punch instrument, we performed 34 viable subeschar tissue cultures with a secure junction between the eschar and the normal skin.

Results The bacterial study had 29 positive results. Based on these results and the patient’s status, appropriate antibiotics could be selected and administered. The use of suitable antibiotics led to relatively shallow and small exposed wounds.

Conclusions This procedure could be used to detect potentially pathogenic bacteria hidden under black or yellow eschars. Since subeschar infections are often accompanied by multidrug-resistant bacteria, the early detection of hidden infections and the use of appropriate antibiotics are expected to be helpful to patients.

Keywords

Pressure ulcer - Anti-bacterial agents - Infection - Early diagnosis


Publication History

Received: 10 November 2019

Accepted: 22 April 2020

Article published online:
22 March 2022

© 2020. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • REFERENCES

  • 1 Haesler E. National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers: clinical practice guideline Perth: Cambridge Media; 2014
    Google Scholar
  • 2 Black J, Baharestani M, Cuddigan J. et al. National Pressure Ulcer Advisory Panel’s updated pressure ulcer staging system. Urol Nurs 2007; 27: 144-56
    PubMedGoogle Scholar
  • 3 Kang JS. Plastic surgery. 3rd ed. Seoul: Koonja; 2004
    Google Scholar
  • 4 Fisher AR, Wells G, Harrison MB. Factors associated with pressure ulcers in adults in acute care hospitals. Adv Skin Wound Care 2004; 17: 80-90
    CrossrefPubMedGoogle Scholar
  • 5 Nwomeh BC, Yager DR, Cohen IK. Physiology of the chronic wound. Clin Plast Surg 1998; 25: 341-56
    CrossrefPubMedGoogle Scholar
  • 6 Grey JE, Enoch S, Harding KG. Wound assessment. BMJ 2006; 332: 285-8
    CrossrefPubMedGoogle Scholar
  • 7 Martin P. Wound healing: aiming for perfect skin regeneration. Science 1997; 276: 75-81
    CrossrefPubMedGoogle Scholar
  • 8 Kumar V, Abbas AK, Fausto N. et al. Robbins and Cotran pathologic basis of disease. In: Kumar V, Abbas AK, Fausto N. et al. Cellular responses to stress and toxic insult; adaptation, injury, and death. 8th ed.. Philadelphia: Saunders; 2009: 15
    Google Scholar
  • 9 Timothy JJ. Master medicine: microbiology and infection. 3rd ed.. London: Churchill Livingstone; 2007
    Google Scholar
  • 10 Widgerow AD, King K, Tocco-Tussardi I. et al. The burn wound exudate: an under-utilized resource. Burns 2015; 41: 11-7
    CrossrefPubMedGoogle Scholar
  • 11 Felts AG, Grainger DW, Slunt JB. Locally delivered antibodies combined with systemic antibiotics confer synergistic protection against antibiotic-resistant burn wound infection. J Trauma 2000; 49: 873-8
    CrossrefPubMedGoogle Scholar
  • 12 Zhou YP. Clinical evaluation of extensive excision of burn eschar in the presence of septicaemia: analysis of 32 cases. Burns Incl Therm Inj 1984; 10: 200-2
    CrossrefPubMedGoogle Scholar
  • 13 Yang RH, Rong XZ, Hua R. et al. Pharmacokinectics of vancomycin and amikacin in the subeschar tissue fluid in patients with severe burn. Burns 2009; 35: 75-9
    CrossrefPubMedGoogle Scholar
  • 14 McManus WF, Mason Jr AD, Pruitt Jr BA. Subeschar antibiotic infusion in the treatment of burn wound infection. J Trauma 1980; 20: 1021-3
    CrossrefPubMedGoogle Scholar
  • 15 Braga IA, Brito CS, Filho AD. et al. Pressure ulcer as a reservoir of multiresistant Gram-negative bacilli: risk factors for colonization and development of bacteremia. Braz J Infect Dis 2017; 21: 171-5
    CrossrefPubMedGoogle Scholar
  • 16 Drinka P, Bonham P, Crnich CJ. Swab culture of purulent skin infection to detect infection or colonization with antibiotic-resistant bacteria. J Am Med Dir Assoc 2012; 13: 75-9
    CrossrefPubMedGoogle Scholar
  • 17 Zuber TJ. Punch biopsy of the skin. Am Fam Physician 2002; 65: 1155-8
    PubMedGoogle Scholar