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Our initial learning curve in the enzymatic debridement of severely burned hands-Management and pit falls of initial treatments and our development of a post debridement wound treatment algorithm.
Burns 2017; 43(2):326-336B

Abstract

INTRODUCTION

Excisional surgical debridement (SD) is still the gold standard in the treatment of deeply burned hands, though the intricate anatomy is easily damaged. Previous studies demonstrated that enzymatic debridement with the bromelain debriding agent NexoBrid® (EDNX) is more selective and thus can preserve viable tissue with excellent outcome results. So far no method paper has been published presenting different treatment algorithms in this new field. Therefore our aim was to close this gap by presenting our detailed learning curve in EDNX of deeply burned hands.

METHODS

We conducted a single-center prospective observational clinical trial treating 20 patients with deeply burned hands with EDNX. Different anaesthetic procedures, debridement and wound treatment algorithms were compared and main pitfalls described.

RESULTS

EDNX was efficient in 90% of the treatments though correct wound bed evaluation was challenging and found unusual compared to SD. Post EDNX surprisingly the majority of the burn surface area was found overestimated (18 wounds). Finally we simplified our process and reduced treatment costs by following a modified treatment algorithm and treating under plexus anaesthesia bedside through a single nurse and one burn surgeon solely. Suprathel® could be shown to be an appropriate dressing for wound treatment after EDNX. Complete healing (less 5% rest defect) was achieved at an average of day 28.

CONCLUSION

EDNX in deep burned hands is promising regarding handling and duration of the treatment, efficiency and selectivity of debridement, healing potential and early rehabilitation. Following our treatment algorithm EDNX can be performed easily and even without special knowledge in burn wound depth evaluation.

Authors+Show Affiliations

Department of Plastic Surgery, Hand Surgery, Burn Center, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany. Electronic address: schulza@kliniken-koeln.de.Department of Plastic Surgery, Hand Surgery, Burn Center, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany.Department of Plastic and Reconstructive Surgery and Burn Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel.Department of Neurosurgery, Cologne-Merheim Medical Center (CMMC), Cologne, Germany.Department of Neurosurgery, Cologne-Merheim Medical Center (CMMC), Cologne, Germany.Department of Plastic Surgery, Hand Surgery, Burn Center, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany.Department of Plastic Surgery, Hand Surgery, Burn Center, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany.

Pub Type(s)

Clinical Trial
Journal Article
Observational Study

Language

eng

PubMed ID

28341257

Citation

Schulz, A, et al. "Our Initial Learning Curve in the Enzymatic Debridement of Severely Burned hands-Management and Pit Falls of Initial Treatments and Our Development of a Post Debridement Wound Treatment Algorithm." Burns : Journal of the International Society for Burn Injuries, vol. 43, no. 2, 2017, pp. 326-336.
Schulz A, Perbix W, Shoham Y, et al. Our initial learning curve in the enzymatic debridement of severely burned hands-Management and pit falls of initial treatments and our development of a post debridement wound treatment algorithm. Burns. 2017;43(2):326-336.
Schulz, A., Perbix, W., Shoham, Y., Daali, S., Charalampaki, C., Fuchs, P. C., & Schiefer, J. (2017). Our initial learning curve in the enzymatic debridement of severely burned hands-Management and pit falls of initial treatments and our development of a post debridement wound treatment algorithm. Burns : Journal of the International Society for Burn Injuries, 43(2), pp. 326-336. doi:10.1016/j.burns.2016.08.009.
Schulz A, et al. Our Initial Learning Curve in the Enzymatic Debridement of Severely Burned hands-Management and Pit Falls of Initial Treatments and Our Development of a Post Debridement Wound Treatment Algorithm. Burns. 2017;43(2):326-336. PubMed PMID: 28341257.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Our initial learning curve in the enzymatic debridement of severely burned hands-Management and pit falls of initial treatments and our development of a post debridement wound treatment algorithm. AU - Schulz,A, AU - Perbix,W, AU - Shoham,Y, AU - Daali,S, AU - Charalampaki,C, AU - Fuchs,P C, AU - Schiefer,J, Y1 - 2016/10/27/ PY - 2015/05/23/received PY - 2016/06/06/revised PY - 2016/08/09/accepted PY - 2017/3/26/entrez PY - 2017/3/28/pubmed PY - 2017/10/14/medline KW - Bromelain KW - Burn wound KW - Dermis preservation KW - Enzymatic debridement KW - Eschar removal KW - NexoBrid(®) SP - 326 EP - 336 JF - Burns : journal of the International Society for Burn Injuries JO - Burns VL - 43 IS - 2 N2 - INTRODUCTION: Excisional surgical debridement (SD) is still the gold standard in the treatment of deeply burned hands, though the intricate anatomy is easily damaged. Previous studies demonstrated that enzymatic debridement with the bromelain debriding agent NexoBrid® (EDNX) is more selective and thus can preserve viable tissue with excellent outcome results. So far no method paper has been published presenting different treatment algorithms in this new field. Therefore our aim was to close this gap by presenting our detailed learning curve in EDNX of deeply burned hands. METHODS: We conducted a single-center prospective observational clinical trial treating 20 patients with deeply burned hands with EDNX. Different anaesthetic procedures, debridement and wound treatment algorithms were compared and main pitfalls described. RESULTS: EDNX was efficient in 90% of the treatments though correct wound bed evaluation was challenging and found unusual compared to SD. Post EDNX surprisingly the majority of the burn surface area was found overestimated (18 wounds). Finally we simplified our process and reduced treatment costs by following a modified treatment algorithm and treating under plexus anaesthesia bedside through a single nurse and one burn surgeon solely. Suprathel® could be shown to be an appropriate dressing for wound treatment after EDNX. Complete healing (less 5% rest defect) was achieved at an average of day 28. CONCLUSION: EDNX in deep burned hands is promising regarding handling and duration of the treatment, efficiency and selectivity of debridement, healing potential and early rehabilitation. Following our treatment algorithm EDNX can be performed easily and even without special knowledge in burn wound depth evaluation. SN - 1879-1409 UR - https://www.unboundmedicine.com/medline/citation/28341257/Our_initial_learning_curve_in_the_enzymatic_debridement_of_severely_burned_hands_Management_and_pit_falls_of_initial_treatments_and_our_development_of_a_post_debridement_wound_treatment_algorithm_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0305-4179(16)30287-X DB - PRIME DP - Unbound Medicine ER -