Elsevier

Burns

Volume 38, Issue 1, February 2012, Pages 108-112
Burns

Efficacy of enzymatic debridement of deeply burned hands

https://doi.org/10.1016/j.burns.2011.06.002Get rights and content

Abstract

Background

The burned hand is a common and difficult to care-for entity in the field of burns. Due to the anatomy of the hand (important and delicate structures crowded in a small limited space without sub-dermal soft tissue), surgical debridement of the burned tissue is technically difficult and may cause considerable complications and, therefore, should be performed judiciously.

Selective enzymatic debridement of the burn wound can preserve the spontaneous epithelialisation potential and reduce the added injury to the traumatised tissue added by a surgical debridement.

Objective

The aim of the study was to assess the implication of a selective enzymatic compound (Debrase® – Ds) in the special field of deep hand burns, by comparing the actual burn area that required surgical coverage after enzymatic debridement to the burn area clinically judged to require skin grafting prior to debridement.

Materials and methods

This was a retrospective data collection and analysis from 154 complete files of prospective, open-label study in 275 hospitalised, Ds-treated burn patients.

Results

A total of 69 hand burns diagnosed as ‘deep’ was analysed; 36% of the wounds required surgical intervention after enzymatic debridement; 28.6% of the total burned area estimated initially as deep was covered by skin graft (statistically significant p < 0.001).

Conclusion

Debridement of deep-hand burns with a selective enzymatic agent decreased the perceived full-thickness wound area and skin-graft use.

Section snippets

Materials and methods

Between 1985 and 1999, more than 300 burn patients were treated by Ds in the Soroka Medical Center burn unit within the framework of an open prospective study, approved by the institutional and national Helsinki Committees.

Burn depth was clinically assessed on admission to the ER by visual inspection, tactile inspection and by assessing blanching with pressure and capillary refill [20]. Burn wounds that were clinically assessed as deep dermal or full thickness, which according to our routine

Results

A total of 57 patients with 69 hand-burn wounds estimated as deep was analysed.

Other than pain, no enzymatic-debridement-related adverse events were recorded. Pain during Ds’ application was controlled by analgesia upon request. No anaesthesia was performed. The mean area of the hand-burn wounds which were initially estimated as deep was 1.4 ± 0.8% of total body surface area (TBSA).

Debridement has been initiated, on average, 0.9 days post-admission and completed in 4 h.

After debridement, 25 hands

Discussion

A previous study has demonstrated that often the excised burn eschar contains viable tissue: microscopically unaltered normal deep dermis, unaltered dermal collagen fibres and transected normal capillaries [24].

All hand-burn wounds treated in this study would have undergone tangential excision and grafting, if treated according to current state-of-the-art clinical practice.

Enzymatic debridement decreased both the number of patients with burns who eventuated in an operative procedure and the

Financial disclosure

The study was initiated in 1983 in the Soroka Burn Unit at the request of Drs. Klein and Houck who donated the Debridase enzyme. In 1992 GMP material for the study was produced and donated by Biotechnology General Ltd. Israel (BTG Ltd.). Since January 2002, Lior Rosenberg (LR) – one of the authors, is also the Chief Medical Director of MediWound Ltd. that produces the new improved Debridase preparation under the name of “Debrase”. LR did not have any financial interests in the company at the

Acknowledgements

Since January 2002, Lior Rosenberg is also the Chief Medical Director of MediWound Ltd. that produces the Debridase preparation under the name of ‘Debrase’. LR did not have any financial interests in the company at the time of the study (1984–1999).

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