[Results of vacuum therapy (v.a.C.) of superficial and deep dermal burns].
BACKGROUND
This prospective multi-centre study in co-operation with the Wake Forrest University covered the area of applications for treatment of fresh, superficial and deep dermal burns and scalds (grade II a-b). The micro-circulation relationships, wound healing time, extent of germ settlement and the connective tissue edema were of particular interest (together with the increase or decrease in burn depth). Moreover, the economical aspects were compared with conservative therapy.


METHODS
his study was carried out on our intensive care ward on 11 patients suffering from burn injuries and we took the healing process as the basis (2001-2003). Inclusion criteria for the study were burns on both hands, degree II a-b, occurring trauma less than 6 hours ago and a treatment period of minimum 48 hours. In any case the hands inflicted with deeper and extensive burns (assessment by 2 experienced, independent appraising plastic surgeons) were subject to V.A.C. therapy. The standard conventional, conservative therapy applied to the other hand was taken for comparison or control purposes to determine the success. Since October 2001 we use the IC-View perfusography with ICG colouring (ICG pulsion, PULSION Medical Systems AG, Munich, Germany) for objective findings both previously and during the course of treatment. A respective quantitative analysis and assessment of the recorded video sequences were made with the help of special software (IC-CALC, PULSION Medical Systems AG, Munich, Germany). Here too, the intensity of the fluorescence indicated the blood circulation through the connective tissue and is on the same level. Basis for this method of study was the work of Holm et al. in our department.


RESULTS
Above all, the results of our study revealed a significant reduction or prophylaxis of the connective tissue edema. Due to improvement in the micro-circulation, also supported by dynamic IC-View laser-fluorescence videography it could be determined that the wound healing process was quicker and without complication in the majority of cases. This was all the more true, although even when the extent of the deep dermal hand burns treated by V.A.C. therapy was greater than on the hand taken for comparison. Extending the therapy applied to the hand to the entire extremity could contribute to avoiding operative stress (escharotomy) in selected cases. Troublesome supporting of the hands and the ergotherapeutic use of splints were not necessary because of the exact fixation of the extremities ensured by the vacuum method. The advantage became more obvious when both the cost factor and time expenditure were considered and compared with previous conservative therapy.


CONCLUSIONS
In the near future the treatment of superficial and deep dermal burns/scalds by V.A.C. therapy can help in reducing the expenditure in time, material and personnel when treating large area wounds. A further advantage is not only to be seen in the optimised healing process in the case of superficial and deep dermal burn wounds but also in the reduction or even avoidance of extensive escharotomy with the accompanying operation trauma. In this respect close mesh control of the blood circulating conditions appeared to us to be important and as a result of our study V.A.C. therapy was approved in December 2002 for the treatment of superficial and deep dermal burns by FDA (Dept. of Health and Human Services).
Schrank
C
C
Abt. für Plastische-, Rekonstruktive- und Handchirurgie, Zentrum für Schwerbrandverletzte, Städt. Klinikum München-Bogenhausen. schrank@gedik.de
Mayr
M
M
Overesch
M
M
Molnar
J
J
Henkel V  Donnersmarck
G
G
Mühlbauer
W
W
Ninkovic
M
M
D002056:Burns / Q000145:classification / Q000601:surgery*; D003646:Debridement / Q000295:instrumentation*; D004867:Equipment Design; D005500:Follow-Up Studies; D006230:Hand Injuries / Q000145:classification / Q000601:surgery*; D006801:Humans; D007362:Intensive Care Units; D008838:Microcomputers; D009779:Occlusive Dressings; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D012867:Skin / Q000098:blood supply; D025321:Surgery, Computer-Assisted / Q000295:instrumentation; D013536:Suture Techniques / Q000295:instrumentation*; D013673:Technology Assessment, Biomedical; D014618:Vacuum; D014945:Wound Healing / Q000502:physiology