Escharotomy using an enzymatic debridement agent for treating experimental burn-induced compartment syndrome in an animal model.
BACKGROUND
In patients with deep circumferential burns, adequate resolution of burn-induced compartment syndrome (BICS) is achieved by surgical escharotomy. Surgical escharotomy is traumatic, may cause considerable blood loss, does nothing toward debridement of the burn wound, and entails possible morbidity and complications. Debridase is a Bromelain derived enzymatic preparation capable of lysing the burn eschar within 4 hours, obviating the need for surgical debridement. It has an affinity to burned necrotic tissue and does not damage healthy skin. In our clinical assessment of the Debridase efficacy, we found in several cases of deep burns of the limbs that the measured IC pressure subsided after 2-4 hours of Debridase application and none of the enzymatic escharotomy treated patients suffering from circumferential burns developed BICS. To confirm these observations we conducted this controlled study.


OBJECTIVE
to assess the efficacy of Debridase for treating BICS in an animal model.


METHODS
A model for BICS was developed by making circumferential burns to pig legs and monitoring the anterior compartment the legs. BICS was induced in the legs of 5 pigs, 20 legs. 10 legs were treated with Debridase and 10 served as nontreated controls, treated by surgical escharotomy at the conclusion of the experiment.


RESULTS
Debridase reduced BICS within 30 minutes from application. Debridase was as effective as a standard surgical escharotomy.


CONCLUSIONS
Escharectomy using an effective enzymatic debriding agent is potentially an adequate, simple, fast and effective procedure to treat BICS, it has the added benefit of burn debridement without surgical escharotomy.
Department of Plastic and Reconstructive Surgery, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva 84101, Israel.
Yuval
Y
Krieger
Lior
L
Rosenberg
Oren
O
Lapid
Ronen
R
Glesinger
Alex
A
Bogdanov-Berezovsky
Eldad
E
Silberstein
Amiram
A
Sagi
Keith
K
Judkins
D000818:Animals; D001963:Bromelains; D002056:Burns / Q000150:complications; D003161:Compartment Syndromes / Q000188:drug therapy* / Q000209:etiology; D003646:Debridement / Q000379:methods*; D004195:Disease Models, Animal; D007641:Keratolytic Agents; D013552:Swine
D007641:Keratolytic Agents; D001963:Bromelains