Enzymatic debridement of burn wound with collagenase in children with partial-thickness burns

Burns ◽  
2002 ◽  
Vol 28 (8) ◽  
pp. 791-794 ◽  
Author(s):  
Coşkun Özcan ◽  
Orkan Ergün ◽  
Ahmet Çelik ◽  
Nergül Çördük ◽  
Geylani Özok
Keyword(s):  
Burn Wound ◽  
Partial Thickness ◽  
Partial Thickness Burns ◽  
Enzymatic Debridement

Bromelain-based enzymatic debridement of e-cigarette burns: a single unit experience

2019 ◽  
Vol 28 (11) ◽  
pp. 758-761
Author(s):  
Weiguang Ho ◽  
Christopher D. Jones ◽  
Daniel Widdowson ◽  
Hilal Bahia
Keyword(s):  
Total Body Surface Area ◽  
Case Series ◽  
Skin Grafting ◽  
Burn Injuries ◽  
Chemical Burns ◽  
Burn Wound ◽  
Total Body ◽  
Partial Thickness Burns ◽  
Enzymatic Debridement

Objective: It is widely accepted that the early debridement of burns improves outcome. There is increasing evidence that enzymatic debridement is an effective technique for removal of full-thickness and deep-dermal burns, reducing blood loss and often the need for autologous skin grafting by avoiding over excision of the burn. We aim to highlight the potential use of this form of debridement as an alternative to surgical management in patients with electronic cigarette (e-cigarette)-associated flame burn injuries. Methods: This case series presents the use of Nexobrid (MediWound Ltd, Israel), a non-surgical, bromelain-based enzymatic debridement technique, in patients with deep partial-thickness burns (range: 1–3% total body surface area), avoiding the need for autologous skin grafting. Results: Burn wounds in two patients healed within 14 days without complications or the need for further surgical intervention. Another patient required further dressings after discharge but failed to attend follow-up appointments. These results are comparable with those reported by others using conservative management of e-cigarette burns. Conclusion: The authors wish to raise awareness of the potential for a combination of thermal and chemical burns related to e-cigarette explosions. Chemical burns should be excluded by pH testing of the burn wound. From our experience, small e-cigarette-associated flame burns can be considered for management with enzymatic debridement.

Hyperspectral Imaging With Burn Contour Extraction for Burn Wound Depth Assessment

2018 ◽  
Vol 1 (4) ◽  
Author(s):  
Houzhu Ding ◽  
Robert C. Chang
Keyword(s):  
Hyperspectral Imaging ◽  
Assessment Tool ◽  
Color Image ◽  
Early Stage ◽  
Principal Component ◽  
Medical Intervention ◽  
Burn Wound ◽  
Thermal Burn ◽  
Partial Thickness ◽  
Partial Thickness Burns

Skin thermal burn wounds are classified according to subjective assessments of wound depth that indicate divergent modes of medical intervention. However, clinically discriminating superficial partial from deep partial thickness burns remains a significant challenge, where only the latter requires excision and skin grafting. Motivated by the need for and ramifications of an objective burn wound assessment tool, this paper advances hyperspectral imaging (HSI) in a porcine skin burn model to quantitatively evaluate thermal burn injuries (superficial and deep partial thickness burns). Two-dimensional (2D) principal component analysis for noise reduction is applied to images captured by HSI in the visible wavelength range. Herein, a multivariate regression analysis is used to calculate the total hemoglobin concentration (tHb) and the oxygen saturation (StO2) of the injured tissue. These perfusion profiles are spatially mapped to yield characteristic distributions corresponding to the burn wound degree validated histologically. The results demonstrate that StO2 and tHb diverge significantly for superficial partial and deep partial burns at 24 h and 1 h, respectively (p < 0.05). A StO2 burn map at 1 h post-burn yields a 2D burn contour that is registered with a burn color image. This early stage burn-specific contour has implications to guide downstream burn excision and grafting.

The Effects of Rapid Enzymatic Debridement of Deep Partial-Thickness Burns With Debrase® on Wound Reepithelialization in Swine

2010 ◽  
Vol 31 (5) ◽  
pp. 795-802 ◽  
Author(s):  
Adam J. Singer ◽  
Breena R. Taira ◽  
Ryon Anderson ◽  
Steve A. McClain ◽  
Lior Rosenberg
Keyword(s):  
Partial Thickness ◽  
Partial Thickness Burns ◽  
Enzymatic Debridement

Injectable Small Intestinal Submucosa and Adipose-Derived Stem Cells Composite Gel Promoting The Deep Partial-Thickness Burns Repair

2021 ◽  
Author(s):  
Xing Guo ◽  
Jiang Guo ◽  
Hong Zhou ◽  
Denghua Huang ◽  
Longfei Zou ◽  
...  
Keyword(s):  
Stem Cells ◽  
Small Intestinal Submucosa ◽  
Vascular Density ◽  
Burn Wound ◽  
Partial Thickness ◽  
Composite Gel ◽  
Small Intestinal ◽  
Intestinal Submucosa ◽  
Partial Thickness Burns

Abstract Backgroud: Burns wound treatment remains a significant clinical challenge around the world. Although stem cell-based scaffold therapies are promising strategy for burn wounds, its clinical therapeutic effect is still not satisfactory nowadays. Herein the aim of this study is to evaluate the therapeutic efficacy of injectable small intestinal submucosa (SIS) and rat adipose-derived mesenchymal stem cells (ADSCs) composite gel to repair the deep partial thickness burns in rats. Methods The deep partial-thickness burns model in rats were made by contacting the dorsal surface SIS memberance directly with boiled water for 10 seconds. After scalding, the wound edge and the central area were injected for phosphate-buffered saline (PBS) solution, ADSCs, injectable SIS and injectable SIS/ ADSCs composite gel, respectively. At 3, 7, 14 and 21 days post injection treatment, the burn wound closure percentages were evaluated. Moreover, micro-vascular density and epidermal thickness assessment in burn wound were performed by histopathology examination or immunofluorescence. Besides, the expression of genes related to wound angiogenesis and re-epithelialization were determined in vitro. Results Our data revealed that that injectable SIS gel could provide a well-grown microenvironment for ADSCs in vitro, and the ADSCs-SIS composite gel could synergistically promote the deep partial-thickness burn repair via paracrine and differentiation mechanisms. Conclusions Taken together, this study shows the ADSCs-SIS composite gel is a promising candidate for burn wound regeneration.

scholarly journals Application of Polyethylene Cling Film to Underpin Moist Burn Wound Therapy

2020 ◽  
Vol 3 (2) ◽  
pp. 229-238
Author(s):  
Qutaiba Aldoori ◽  
Aasem Albyti ◽  
Muthanna Hussein
Keyword(s):  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Wound Dressings ◽  
Control Group ◽  
Joint Movement ◽  
Burn Wound ◽  
Partial Thickness ◽  
Background Pain ◽  
Cling Film ◽  
Partial Thickness Burns

Background Dermal burns (partial thickness burns) are the most painful trauma with two types of pain background pain with additional procedural pain, one of the best tolerable mode of treatment that commonly used now adays is treatment with MEBT ointments to maintain the moist and warm wound environment suitable for regeneration of epidermal cells, and to reduces pain. Moist wound dressings retain moisture, heat, body fluids, and biofilm with medication. The assumption is that the polyethylene film will maintain the ointment and its effect more than to be used merely. Patients and methods Prospective study to evaluate treatment of patients with partial thickness burns conservatively with MEBT ointment as a control group and MEBT ointment + Cling Film, 63 patients being admitted to the burn center at Azadi teaching hospital during a period of one year starting from June 2018 till June 2019. The inclusion criteria including all patients between 10-95% partial thickness burns of various age, sex and skin types. Results Very much decrease in procedural and background pain, better joint movement in physiotherapy decrease in crust formation, increase maceration of eschar, better cost- effectiveness, less days of hospital stay. Aim; in Iraq circumstances we have to use the most cost effective measures to reach our goals in managing the burn wounds the moist trend which is now being proved it gives better healing with less pain, with best criteria of wound dressing . Conclusion Easily applicable, less painful, non-coasty over all, better condition of patient during course of management, reduced length of hospital stay and lower treatment costs, appropriate wound healing with living tissue , less joint stiffness problems

664 “Minimally Invasive” Skin Grafting with Enzymatic Debridement and Autologous Skin Cell Spray

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S187-S188
Author(s):  
Steven Kahn ◽  
Ashley Hink ◽  
Jordan Karsch ◽  
Elizabeth Halicki ◽  
William L Hickerson ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Skin Graft ◽  
Donor Site ◽  
Standard Of Care ◽  
Full Thickness ◽  
Skin Cell ◽  
Partial Thickness ◽  
Small Pore ◽  
Partial Thickness Burns ◽  
Enzymatic Debridement

Abstract Introduction Minimally invasive surgery is increasingly becoming standard of care across numerous subspecialties. However, burn surgery has lagged behind; as the mainstay of reconstruction still involves wound excision with a knife, a commensurately sized skin graft, and a painful donor site. In recent years, several new technologies have the potential to be used synergistically to perform “minimally invasive” skin grafts. Enzymatic debridement with bromelain and autologous skin cell spray (ASCS) have independently been shown to reduce the need for split-thickness skin graft (STSG) and decrease the donor site size when grafting is performed. Bromelain is more likely to preserve healthy dermis and ASCS allows an 80:1 expansion. Due to constraints regarding the temporal course of these products only being available via studies before one was FDA approved, these two therapies have not been utilized together in the US until recently. A paucity of literature regarding their use in combination currently exists. Methods This study is a single site review of patients treated the continued access study protocol for bromelain-based enzymatic debridement and with ASCS per the FDA-approved instructions for use. Enzymatic debridement was performed over a 4-hour period with appropriate analgesia. Deep partial-thickness burns with residual dermis were treated with ASCS after enzymatic debridement and superficial dermabrasion. Wounds were dressed with a small pore non-adherent film and layered gauze. Full-thickness burn injuries were treated with conventional STSG. Results Two patients were treated over a 2 week period. One was a 51 yr old male with 17% TBSA superficial and deep partial thickness flame burns, of which 11% were deemed deep enough to warrant treatment with enzymatic debridement. 15% TBSA was treated with ASCS including the arms, back, and posterior neck with a 24 sq cm donor site. Wound closure was noted post-operative day 7 with complete re-epithelialization. The second patient was a 21-year-old male with several comorbidities impairing wound healing (diabetes [HgbA1c of 9.9], scurvy, and zinc deficiency. He had deep-partial and full-thickness burns to bilateral feet. The dorsum of the right foot was reconstructed with ASCS only and a 6 sq cm donor site, and the left foot was treated with a 3:1 meshed STSG and ASCS overspray with 100% take. Conclusions Enzymatic debridement and ASCS can be utilized to treat deep partial-thickness burns with a “minimally invasive” reconstruction. The donor sites in both patients were much smaller than had they been treated with a conventional meshed STSG. Further study is needed to determine which subsets of patients and burn wound characteristics are optimal for this combination of technologies. More data regarding outcomes such as length of stay, costs, and scar formation compared to standard of care is also warranted.

Pediatric Burn Treatment Using Tilapia Skin as a Xenograft for Superficial Partial-Thickness Wounds: A Pilot Study

2019 ◽  
Author(s):  
Edmar Maciel Lima Júnior ◽  
Manoel Odorico de Moraes Filho ◽  
Antonio Jorge Forte ◽  
Bruno Almeida Costa ◽  
Francisco Vagnaldo Fechine ◽  
...  
Keyword(s):  
Pilot Study ◽  
Test Group ◽  
Silver Sulfadiazine ◽  
Control Group ◽  
Burn Wound ◽  
Open Label ◽  
Burn Treatment ◽  
Partial Thickness ◽  
Partial Thickness Burn ◽  
Partial Thickness Burns

Abstract This study aims to evaluate the efficacy of Nile tilapia skin as a xenograft for the treatment of partial-thickness burn wounds in children. This is an open-label, monocentric, randomized phase II pilot study conducted in Fortaleza, Brazil. The study population consisted of 30 children between the ages of 2 and 12 years with superficial “partial-thickness” burns admitted less than 72 hours from the thermal injury. In the test group, the tilapia skin was applied. In the control group, a thin layer of silver sulfadiazine cream 1% was applied. Tilapia skin showed good adherence to the wound bed, reducing the number of dressing changes required, the amount of anesthetics used, and providing benefits for the patients and also for healthcare professionals, by reducing the overall work load. The number of days to complete burn wound healing, the total amount of analgesics required throughout the treatment, burn improvement on the day of dressing removal, and pain throughout the treatment were similar to the conventional treatment with silver sulfadiazine. Thus, tilapia skin can be considered an effective and low-cost extra resource in the therapeutic arsenal of pediatric superficial partial thickness burns.

scholarly journals Evolution of a concept with enzymatic debridement and autologous in situ cell and platelet-rich fibrin therapy (BroKerF)

2022 ◽  
Vol 8 ◽  
pp. 205951312110523
Author(s):  
Matthias Waldner ◽  
Tarek Ismail ◽  
Alexander Lunger ◽  
Holger J Klein ◽  
Riccardo Schweizer ◽  
...  
Keyword(s):  
Fibrin Glue ◽  
Healing Process ◽  
Donor Site ◽  
Total Body Surface Area ◽  
Split Thickness Skin Graft ◽  
Skin Grafts ◽  
Skin Cells ◽  
Partial Thickness ◽  
Partial Thickness Burns ◽  
Enzymatic Debridement

Background Deep partial-thickness burns are traditionally treated by tangential excision and split thickness skin graft (STSG) coverage. STSGs create donor site morbidity and increase the wound surface in burn patients. Herein, we present a novel concept consisting of enzymatic debridement of deep partial-thickness burns followed by co-delivery of autologous keratinocyte suspension and plated-rich fibrin (PRF) or fibrin glue. Material and methods In a retrospective case study, patients with deep partial-thickness burns treated with enzymatic debridement and autologous cell therapy combined with PRF or fibrin glue (BroKerF) between 2017 and 2018 were analysed. BroKerF was applied to up to 15% total body surface area (TBSA); larger injuries were combined with surgical excision and skin grafting. Exclusion criteria were age <18 or >70 years, I°, IIa°-only, III° burns and loss of follow-up. Results A total of 20 patients with burn injuries of 16.8% ± 10.3% TBSA and mean Abbreviated Burn Severity Score 5.45 ± 1.8 were identified. Of the patients, 65% (n = 13) were treated with PRF, while 35% (n = 7) were treated with fibrin glue. The mean area treated with BroKerF was 7.5% ± 0.05% TBSA, mean time to full epithelialization was 21.06 ± 9.2 days and mean hospitalization time was 24.7 ± 14.4 days. Of the patients, 35% (n = 7) needed additional STSG, 43% (n = 3) of whom had biopsy-proven wound infections. Conclusion BroKerF is an innovative treatment strategy, which, in our opinion, will show its efficacy when higher standardization is achieved. The combination of selective debridement and autologous skin cells in a fibrin matrix combines regenerative measures for burn treatment. Lay Summary Patients suffering from large burn wounds often require the use of large skin grafts to bring burned areas to heal. Before the application of skin grafts, the burned skin must be removed either by surgery or using enzymatic agents. In this article, we describe a method where small areas of skin are taken and skin cells are extracted and sprayed on wound areas that were treated with an enzymatic agent. The cells are held in place by a substance extracted from patients’ blood (PRF) that is sprayed on the wound together with the skin cells. We believe this technique can be helpful to reduce the need of skin grafts in burned patients and improve the healing process.

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