Dr. Brian Fumio Mayeda, MD

Debridement can be performed either surgically or nonsurgically; some methods are less invasive than others. Doctors select the appropriate debridement technique by considering the location, cause, and size of a patient's wound and may also weigh the patient's overall wellbeing, age, and risk of infection.

Surgical debridement is performed by cutting away dead, infected, and hyperkeratotic skin with a surgical scalpel. For deep wounds that tear away the skin and go into the muscle, skin from another region of a patient's body may be grafted onto the wound, which may then be periodically assessed and rebandaged until fully healed.

Non-surgical debridement is achieved with water or a dissolvent gel. Water softens the damaged skin and affected tissue, allowing doctors to remove it with wet-to-dry dressing. When wet tissue dries, it adheres to the dry dressing or bandage and comes off when the dressing is pulled away. In contrast, dissolvent gel deconstructs tissue, which can be cleaned off of the wound. Nonsurgical debridement is less invasive than surgical techniques; however, it can entail repeat treatments, slowing wound recovery.

While the prospect of stripping away skin may seem jarring, debridement can be critical to the treatment and healing of wounds which cannot not heal independently.

Joint problems include bursitis and arthritis. Bursitis is the inflammation of a fluid-filled sac cushion on the outside of a joint, causing symptoms including pain and swelling. Arthritis is the inflammation and damage of a joint due to wear and tear or disease. There are several treatments for arthritis, but if the damage progresses far enough, joint replacement may be necessary. In joint replacement, a metal or plastic implant is surgically placed within the joint to make movement easier.

Bone problems include scoliosis, fractures, and osteoporosis. Scoliosis is a curvature of the spine, making the normally straight spine look like a 'C' or 'S.' It is treated with braces or surgery. Osteoporosis is a disease that causes bones to weaken and break easily. It's most common in women, especially older women. Fully half of all women over 65 have osteoporosis. Fractures are any break in the bone. They can be a simple crack or a severe and complicated shatter. Osteoporosis causes fractures in people who have it, but other causes are trauma (such as a fall) or overuse.

Tendon and ligament problems most often result from injury or overuse. Two good examples are ligament tears and tendonitis. The most common ligament tear is the ACL tear in the knee. This ligament supports and stabilizes the knee and is most often torn during sports activities. Tendonitis happens when a tendon, which connects muscles and bones together, becomes irritated and inflamed. This happens most often in older patients who push their bodies too far, leading to pain and swelling. Treatment for both tendon and ligament problems usually includes rest, ice, and supporting the area to let it heal.

Pain and numbness problems can be caused by overuse, disease, an injury, or a compressed nerve. Lower back pain and carpal tunnel syndrome are two of the most common conditions patients encounter. Lower back pain may be caused by sore muscles that have been overworked, or an injury to the disks separating the vertebrae in the spine. Lower back pain usually goes away on its own within a few days, but it may require medical treatment depending on the cause. Carpal tunnel syndrome occurs when the nerve at the base of the palm becomes trapped or pinched. Symptoms include tingling, pain, numbness, or weakness in the hand. Treatment involves rest and sometimes steroid injections.

Because the musculoskeletal system involves so much of the body, problems here can be incredibly varied in their type and severity. Some musculoskeletal problems will go away on their own or only require rest, while others may require medication, physical therapy, or even surgery.

Although joint replacement is one of the safest and most reliable medical procedures available, it is still a major surgical procedure. All surgical procedures carry risks, such as infection or blood clots. For this reason, doctors try to help their patients avoid surgery for as long as they can. Taking arthritis medications, losing weight, avoiding high impact sports such as running, taking supplements such as glucosamine or chondroitin, or having joint injections may allow a patient to enjoy life without the need for surgery.

After having joint replacement surgery, patients can expect some pain the first few days as they recover. Physical therapy is an important part of recovery, and it can decrease complications and increase future mobility. As soon as possible, returning to low impact sports such as swimming, walking or biking can stretch and heal the new joint. A prosthetic joint can last 15 - 20 years and cannot be further damaged by degenerative diseases such as arthritis, so once it is done patients should be pain-free for many years.