Universität zu Köln

Schulz, A., Perbix, W., Shoham, Y., Daali, S., Charalampaki, C., Fuchs, P. C. and 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, 43 (2). S. 326 - 337. OXFORD: ELSEVIER SCI LTD. ISSN 1879-1409

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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 bum 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. (C) 2016 Elsevier Ltd and ISBI. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Schulz, A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Perbix, W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Shoham, Y. UNSPECIFIED UNSPECIFIED UNSPECIFIED Daali, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Charalampaki, C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Fuchs, P. C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schiefer, J. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-238347
DOI:	10.1016/j.burns.2016.08.009
Journal or Publication Title:	Burns
Volume:	43
Number:	2
Page Range:	S. 326 - 337
Date:	2017
Publisher:	ELSEVIER SCI LTD
Place of Publication:	OXFORD
ISSN:	1879-1409
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PARTIAL-THICKNESS BURNS; SKIN-GRAFT; DONOR SITES; BIOBRANE; SUPRATHEL(R); ANESTHESIA; TISSUE; SUBSTITUTE; DRESSINGS; CHILDREN Multiple languages Critical Care Medicine; Dermatology; Surgery Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/23834