Effect of Radiofrequency Ablation on Healing of Infected Full-Thickness Wounds in Minipigs

Salvage radiofrequency ablation for microwave ablation treated hepatocellular carcinoma complicated by gas gangrene: case report

AIM

Gas gangrene (GG) is a rare severe infection with a very high mortality rate mainly caused by Clostridium species. It develops suddenly, often as a complication of abdominal surgery or liver transplantation. We report a case of GG of the liver occurred after percutaneous microwave (MW) ablation of an hepatocellular carcinoma (HCC) successfully treated with percutaneous Radiofrequency ablation (RFA).

CASE PRESENTATION

A 76-year-old female patient was treated with MW ablation for a large HCC in the VIII segment; 2 days later she developed fever, weakness, abdominal swelling and was hospitalized with diagnosis of anaerobic liver abscess. Despite antibiotic therapy, the patient conditions worsened, and she was moved to the intensive care unit (ICU). Percutaneous drainage was attempted, but was unsuccessful. The surgeon and the anesthesiologist excluded any indication of surgical resection. We performed RFA of the GG by 3 cool-tip needles into the infected area. The procedure was well tolerated by the patient, who left the hospital for follow-up.

CONCLUSION

Percutaneous RFA could be a valuable therapy of focal GG of the liver in patients refractory to antibiotics and when surgery and OLT are not feasible. A fast and early indication is needed in case of rapid worsening of the patient's conditions.

Coblation Versus Surgical Debridement Against MRSA Infection in Wounds With Shrapnel: A Preliminary Study

INTRODUCTION

Debridement plays a critical role in wound management. In addition to removing necrotic tissue, debridement can eliminate bacteria frequently harbored within the tissue. This study evaluated a novel debridement method that uses plasma-based radiofrequency technology to remove tissue and bacteria. Coblation is a technology that uses radiofrequency energy to excite the electrolytes in a conductive medium, such as saline, to create a precisely focused plasma. This plasma field contains highly energized particles that possess sufficient energy to break tissue molecular bonds, causing the tissue to dissolve at relatively low temperatures (typically 40 °C to 70 °C).

MATERIALS AND METHODS

Eighteen deep dermal wounds measuring 22 mm × 22 mm × 3 mm deep were created on pigs. Wounds were inoculated with methicillin-resistant Staphylococcus aureus USA300 (MRSA USA300) in combination with shrapnel and then covered with a polyurethane dressing for 24 hours. Wounds were then randomly assigned to one of the 3 treatment groups: (1) Coblation, (2) surgical debridement, and (3) no debridement. Wounds were biopsied on days 0, 5, 9, and 12, and specimens were processed for MRSA counts using selective media. Statistical analysis was performed using IBM SPSS statistics 27 using one-way ANOVA.

RESULTS

Comparison between coblation and surgical debridement showed a decrease in bacterial count in all assessment times. The lowest bacterial count in all assessment times was observed in wounds debrided with coblation showing a statistically significant (P ≤ .05) decrease in more than 2 Log CFU/g on days 0, 5, and 9 compared to no debridement. On day 12, coblation-debrided wounds exhibited 6.10 ± 0.22 Log CFU/g, and this value represents 99.99% of reduction compared with non-debrided wounds (P ≤ .05). More than 96% of reduction (P ≤ .05) resulted in wounds treated with coblation compared with surgically debrided.

CONCLUSIONS

Reducing MRSA bacterial infection counts, especially of biofilm-associated organisms, in combination with shrapnel may have important clinical implications, especially for the military personnel. Further research into the use of this technology in wound management is warranted.

A comparison of radiofrequency Coblation and cold steel excision in the treatment of idiopathic vocal process granulomas

OBJECTIVE

To compare the effectiveness of radiofrequency Coblation assisted excision and cold steel excision in the treatment of idiopathic vocal process granulomas.

METHODS

A retrospective study was performed of patients with idiopathic vocal process granulomas who underwent radiofrequency Coblation excision or cold steel excision between January 2013 and January 2020. The recurrence rate was compared among the two groups at six months post-operatively.

RESULTS

Of the 47 patients with vocal process granulomas, 28 were in the cold steel excision (control) group and 19 were in the Coblation-assisted group. The recurrence rate in the control group was significantly higher than that in the Coblation-assisted group (60.7 per cent vs 5.3 per cent; p < 0.001). In addition, the voice recovery of the Coblation-assisted group was significantly better than that of the control group; vocal quality recovered one month after surgery in the Coblation-assisted group.

CONCLUSION

Radiofrequency Coblation should be considered the optimal method when approaching idiopathic vocal process granulomas surgically.

Comparison Between Coblation and Microflap Resection of Leukoplakia of the Vocal Fold

OBJECTIVES

The objective of this study was to compare the recurrence rate and voice improvement of vocal fold leukoplakia (VFL) between microflap resection alone or radiofrequency (RF) Coblation alone.

METHODS

Patients with VFL intraoperatively treated via microflap resection alone or Coblation alone were enrolled. The recurrence rate, voice assessment, and Videostroboscopic images were compared between the two groups.

RESULTS

The recurrence rate at postoperative 12 months was 37.7% (26/69) in the microflap resection group and 7.7% (4/52) in the Coblation group; the difference was significant (P < 0.05). The preoperative and postoperative subjective detection data from the two groups showed significant differences, but the Coblation group recovered better compared to the microflap resection group. No Coblation-related complications were found, including postoperative granulation tissue hyperplasia or anterior commissure adhesion.

CONCLUSIONS

In patients with vocal cord leukoplakia, RF Coblation had a lower recurrence rate and better voice improvement compared with microflap resection.

[Research progress of chronic wound debridement]

Objective

To review the research progress of chronic wound debridement.

Methods

The recent related literature concerning the mechanisms, advantages, limitations, and indications of the technologies of chronic wound debridement was extensively consulted, reviewed, and summarized.

Results

Debridement is essential for chronic wound healing, which includes autolytic debridement, enzymatic debridement, biodebridement, mechanical debridement, sharp/surgical debridement, ultrasound debridement, hydrosurgery debridement, and coblation debridement. Each technique has its own advantages and disadvantages.

Conclusion

There are many types of technologies of chronic wound debridement, which can be chosen according to clinical conditions. It is showed there are more significant advantages associated with the technique of coblation debridement relatively, which also has greater potential. Further study is needed to improve its efficacy.