Artikel
Deep burns debridement options with emphasis to minimally invasive debridement
Suche in Medline nach
Autoren
-
J. Koller
- Department of Burns and Reconstructive Surgery, Comenius University, Medical Faculty, Bratislava, Slovakia; Department of Burns and Reconstructive Surgery, University Hospital Bratislava, Ruzinov Hospital, Bratislava, Slovakia
-
P. Bukovcan
- Department of Burns and Reconstructive Surgery, Comenius University, Medical Faculty, Bratislava, Slovakia; Department of Burns and Reconstructive Surgery, University Hospital Bratislava, Ruzinov Hospital, Bratislava, Slovakia
-
M. Orsag
- Department of Burns and Reconstructive Surgery, University Hospital Bratislava, Ruzinov Hospital, Bratislava, Slovakia
| Veröffentlicht: | 9. März 2015 |
|---|
Gliederung
Text
Introduction: Currently preferred treatment of deep burns includes early surgical excision of necrotic tissues and immediate closure or coverage of the excised wounds. However, during excisions large amounts of healthy tissues are removed as well and the procedures are associated with large amounts of blood loss. Non-invasive methods of necrotic tissue removal, such as autolytic debridement, or use of proteolytic enzymes, or chemical debridement, have been time consuming and limited due to delayed application, low efficacy and high risk of burn wound infection.
Methods: New plant origin rapidly acting proteolytic enzyme mixture (bromelains – NexoBrid®, MediWound Co.) brought new perspectives enabling minimally invasive methods for deep burn early debridement. Our department participated in two randomized multicenter clinical studies comparing efficacy and safety of this new product with the standard of care (SOC).
Results: A total of 22 patients with deep partial thickness and full thickness burns participated in the 2 studies. NexoBrid® removed selectively necrotic tissues from deep burns by a single 4 hours application without harming healthy tissues. The depth of the debrided wounds could be assessed visually very early, which facilitated the burn depth diagnosis by surgeons. The debrided area could be covered by skin subsitutes until healing or closed by skin grafts. The healig times of NexoBrid® group were comparable with SOC groups. The proven benefits included high selectivity, no surgical excision necessity, managable pain and negligible blood loss. The debrided wounds facilitated early accurate visual burn depth diagnosis and subsequent treatment options according to burn depth.
Conclusions: Early minimally invasive debridement of deep burns by NexoBrid® offers new perspectives in both diagnostics and treatment of deep burns. The advantages include high selectivity, minimal invasivity, negligible blood loss, comparable healing times and comparable or better long-term results.
