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.
BACKGROUND
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 burn 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.


CONCLUSIONS
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.
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.
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Schulz
Department of Plastic Surgery, Hand Surgery, Burn Center, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany.
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Perbix
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.
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Shoham
Department of Neurosurgery, Cologne-Merheim Medical Center (CMMC), Cologne, Germany.
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Daali
Department of Neurosurgery, Cologne-Merheim Medical Center (CMMC), Cologne, Germany.
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Charalampaki
Department of Plastic Surgery, Hand Surgery, Burn Center, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany.
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Fuchs
Department of Plastic Surgery, Hand Surgery, Burn Center, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany.
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Schiefer
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D000758:Anesthesia / Q000379:methods; D001458:Bandages; D001963:Bromelains / Q000627:therapeutic use*; D002056:Burns / Q000534:rehabilitation / Q000628:therapy*; D003646:Debridement / Q000379:methods*; D005260:Female; D006230:Hand Injuries / Q000534:rehabilitation / Q000628:therapy*; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods; D011446:Prospective Studies; D055815:Young Adult
D001963:Bromelains
Bromelain; Burn wound; Dermis preservation; Enzymatic debridement; Eschar removal; NexoBrid(®)