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Enzymatic debridement of deeply burned faces: Healing and early scarring based on tissue preservation compared to traditional surgical debridement.
Burns 2017; 43(6):1233-1243B

Abstract

INTRODUCTION

Facial burns occur frequently and depending on the injured skin layers often heal with scars which may cause permanent functional and cosmetic sequelae. Preservation of the sensitive facial skin layers, especially of the dermis is essential for scarless epithelialisation. Enzymatic debridement of deep thermal burns has already been shown to assist with preserving viable dermis. However, up to date, there are no published reports on wound healing and in the long term aesthetic outcome after enzymatic debridement of facial burns.

METHODS

Therefore we performed a-single centre clinical trial that included 26 subjects aged 18-78 years with facial burns clinically evaluated as deep dermal or deeper. Burns were treated either with enzymatic debridement or excisional surgical debridement. Then we compared both groups regarding debridement selectivity, wound closure and scar quality after more than 12 months.

RESULTS

Enzymatic debridement significantly reduced time to complete wound closure after admission (19.85 days versus 42.23 days, p=0.002), and after enzymatic eschar removal (18.92 days versus 35.62 days, p=0.042). The number of procedures to complete debridement were significantly lower in the enzymatic debridement group (1.00 versus 1.77, p=0.003). 77% of facial burns that had been debrided enzymatically were found to be more superficially burned than initially estimated. Wounds undergoing autografting of any size were significantly reduced by enzymatic debridement (15% versus 77%, p=0.002). Scar quality after enzymatic debridement was superior compared to surgical debridement after 12 months regarding pigmentation (p=0.016), thickness (p=0.16), relief (p=0.10), pliability (p=0.01), surface area (p=0.004), stiffness (p=0.023), thickness (0.011) and scar irregularity (p=0.011). Regarding erythema and melanin, viscoelasticity and pliability, trans-epidermal water loss or laser tissue oxygen saturation, haemoglobin level and microcirculation we found no significant differences for treated and untreated skin in the EDNX group.

CONCLUSION

In our current study we found Bromelain based enzymatic debridement better in some aspects of tissue preservation in deep dermal facial burn.

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 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.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 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 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
Comparative Study
Journal Article

Language

eng

PubMed ID

28363663

Citation

Schulz, Alexandra, et al. "Enzymatic Debridement of Deeply Burned Faces: Healing and Early Scarring Based On Tissue Preservation Compared to Traditional Surgical Debridement." Burns : Journal of the International Society for Burn Injuries, vol. 43, no. 6, 2017, pp. 1233-1243.
Schulz A, Fuchs PC, Rothermundt I, et al. Enzymatic debridement of deeply burned faces: Healing and early scarring based on tissue preservation compared to traditional surgical debridement. Burns. 2017;43(6):1233-1243.
Schulz, A., Fuchs, P. C., Rothermundt, I., Hoffmann, A., Rosenberg, L., Shoham, Y., ... Schiefer, J. (2017). Enzymatic debridement of deeply burned faces: Healing and early scarring based on tissue preservation compared to traditional surgical debridement. Burns : Journal of the International Society for Burn Injuries, 43(6), pp. 1233-1243. doi:10.1016/j.burns.2017.02.016.
Schulz A, et al. Enzymatic Debridement of Deeply Burned Faces: Healing and Early Scarring Based On Tissue Preservation Compared to Traditional Surgical Debridement. Burns. 2017;43(6):1233-1243. PubMed PMID: 28363663.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Enzymatic debridement of deeply burned faces: Healing and early scarring based on tissue preservation compared to traditional surgical debridement. AU - Schulz,Alexandra, AU - Fuchs,Paul Christian, AU - Rothermundt,Irene, AU - Hoffmann,Alexandra, AU - Rosenberg,Lior, AU - Shoham,Yaron, AU - Oberländer,Henrik, AU - Schiefer,Jennifer, Y1 - 2017/03/28/ PY - 2016/08/23/received PY - 2017/02/17/revised PY - 2017/02/24/accepted PY - 2017/4/2/pubmed PY - 2018/5/22/medline PY - 2017/4/2/entrez KW - Bromelain KW - Burn eschar KW - Deep dermal facial burn KW - Dermis preservation KW - Enzymatic debridement KW - Objective and subjective long term scar evaluation SP - 1233 EP - 1243 JF - Burns : journal of the International Society for Burn Injuries JO - Burns VL - 43 IS - 6 N2 - INTRODUCTION: Facial burns occur frequently and depending on the injured skin layers often heal with scars which may cause permanent functional and cosmetic sequelae. Preservation of the sensitive facial skin layers, especially of the dermis is essential for scarless epithelialisation. Enzymatic debridement of deep thermal burns has already been shown to assist with preserving viable dermis. However, up to date, there are no published reports on wound healing and in the long term aesthetic outcome after enzymatic debridement of facial burns. METHODS: Therefore we performed a-single centre clinical trial that included 26 subjects aged 18-78 years with facial burns clinically evaluated as deep dermal or deeper. Burns were treated either with enzymatic debridement or excisional surgical debridement. Then we compared both groups regarding debridement selectivity, wound closure and scar quality after more than 12 months. RESULTS: Enzymatic debridement significantly reduced time to complete wound closure after admission (19.85 days versus 42.23 days, p=0.002), and after enzymatic eschar removal (18.92 days versus 35.62 days, p=0.042). The number of procedures to complete debridement were significantly lower in the enzymatic debridement group (1.00 versus 1.77, p=0.003). 77% of facial burns that had been debrided enzymatically were found to be more superficially burned than initially estimated. Wounds undergoing autografting of any size were significantly reduced by enzymatic debridement (15% versus 77%, p=0.002). Scar quality after enzymatic debridement was superior compared to surgical debridement after 12 months regarding pigmentation (p=0.016), thickness (p=0.16), relief (p=0.10), pliability (p=0.01), surface area (p=0.004), stiffness (p=0.023), thickness (0.011) and scar irregularity (p=0.011). Regarding erythema and melanin, viscoelasticity and pliability, trans-epidermal water loss or laser tissue oxygen saturation, haemoglobin level and microcirculation we found no significant differences for treated and untreated skin in the EDNX group. CONCLUSION: In our current study we found Bromelain based enzymatic debridement better in some aspects of tissue preservation in deep dermal facial burn. SN - 1879-1409 UR - https://www.unboundmedicine.com/medline/citation/28363663/Enzymatic_debridement_of_deeply_burned_faces:_Healing_and_early_scarring_based_on_tissue_preservation_compared_to_traditional_surgical_debridement_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0305-4179(17)30133-X DB - PRIME DP - Unbound Medicine ER -