enzymatic debridement
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Burns ◽  
2022 ◽  
Author(s):  
Karel E.Y. Claes ◽  
Ignace De Decker ◽  
Stan Monstrey ◽  
Yaron Shoham ◽  
Tom Vyncke ◽  
...  

2022 ◽  
Vol 8 ◽  
pp. 205951312110523
Author(s):  
Matthias Waldner ◽  
Tarek Ismail ◽  
Alexander Lunger ◽  
Holger J Klein ◽  
Riccardo Schweizer ◽  
...  

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.


2021 ◽  
Vol 15 (1) ◽  
pp. 66-77
Author(s):  
Lior Rosenberg ◽  
Yaron Shoham ◽  
Stan Monstrey ◽  
Henk Hoeksema ◽  
Jeremy Goverman ◽  
...  

Deep burns are characterized by the presence of a necrotic eschar that delays healing and results in a local and systemic inflammatory response and following healing by secondary intention: heavy scarring. Early surgical debridement followed by grafting was a major advance in deep burn care and is now the standard of care, reducing mortality and hypertrophic scarring. Eschars have alternatively been managed by non-surgical, autolytic debridement, which often results in infection-inflammation, slow epithelialization, granulation tissue formation and subsequent scarring. Studies based on these traditional approaches have demonstrated an association between delayed wound closure (beyond 21 days) and scarring. Early enzymatic debridement with NexoBrid (NXB) followed by appropriate wound care is a novel minimally invasive modality that challenges the well-accepted dictum of a high risk of hypertrophic scarring associated with wound closure that extends beyond 21 days. This is not surprising since early and selective removal of only the necrotic eschar often leaves enough viable dermis and skin appendages to allow healing by epithelialization over the dermis. In the absence of necrotic tissue, healing is similar to epithelialization of clean dermal wounds (like many donor sites) and not healing by the secondary intention that is based on granulation tissue formation and subsequent scarring. If and when granulation islands start to appear on the epithelializing dermis, they and the inflammatory response generally can be controlled by short courses (1-3 days) of topically applied low strength corticosteroid ointments minimizing the risk of hypertrophic scarring, albeit with wound closure delayed beyond the magic number of 21 days. Results from multiple studies and field experience confirm that while deep burns managed with early enzymatic debridement often require more than 21 days to reepithelialize, long-term cosmetic results are at least as good as with excision and grafting.


2021 ◽  
Vol 177 ◽  
pp. S85
Author(s):  
Evdoxia Mathioudaki ◽  
Aikaterini Gouda ◽  
Xanthi Meidoni ◽  
Efstathios Giannakopoulos ◽  
Eleani Kalfa Pateli ◽  
...  

2021 ◽  
pp. 1-11
Author(s):  
Karel Claes ◽  
Henk Hoeksema ◽  
Cynthia Lafaire ◽  
Lieve De Cuyper ◽  
Katrien De Groote ◽  
...  

2021 ◽  
Author(s):  
Angela Tecuceanu ◽  
Teodor Stamate ◽  
Dan Cristian Moraru ◽  
Dobre Costel ◽  
Ilan Marcovici ◽  
...  

2021 ◽  
Vol 17 (3) ◽  
pp. 207-212
Author(s):  
Hong Sil Joo ◽  
Joo Hoen Choi

Early debridement (i.e., eschar removal) is regarded as a cornerstone for treating burn wounds. Although surgical debridement is the standard method for complete removal of eschars, it has inefficiencies such as blood loss, heat loss, and poor selectivity, the latter of which means that both viable and necrotic tissue are affected. To make up for the shortcomings, various alternative techniques have been developed. Nexobrid, a mixture of proteolytic enzymes with high bromelain content, has emerged as a viable option in recent years due to its selectivity and efficiency. This product enables dissolving eschar without sacrificing viable or healthy tissue, preserving the potential for spontaneous epithelialization, which accelerates wound healing and leads to better aesthetic outcomes in burn wounds. Herein, we present our experience with proteolytic enzyme debridement using Nexobrid.


2021 ◽  
Vol 11 (17) ◽  
pp. 8134
Author(s):  
Mihaela Pertea ◽  
Vladimir Poroch ◽  
Petru Ciobanu ◽  
Alexandru Filip ◽  
Natalia Velenciuc ◽  
...  

Background: The use of bromelain for the removal of eschar in deep burns is considered to be effective because it does not affect the unaffected skin and leaves a clean dermis after use. The main objective of this study is to find out whether bromelain is a good alternative to surgical debridement. In order to achieve that, we aim to evaluate its indications, limitations, and safety measures. Methods: The current study was conducted on a group of 30 patients with deep burn lesions, aged 20 to 56 years, from which 15 underwent enzymatic debridement and 15 patients acted as a control group in which primary surgical debridement was used. The mixture of enzymes enriched in bromelain, meant to dissolve burn eschar, was provided by NexoBrid™. The inclusion criteria were in agreement with the manufacturer’s protocols, but the application protocol was slightly modified in order to implement a better intern protocol and to assess its efficiency. Results: Complete eschar debridement was obtained in 13 of the 15 cases, from which 10 patients went through spontaneous healing and 3 needed to be covered with a skin graft. In the other 2 cases, partial eschar debridement was associated with surgical debridement and coverage with split-thickness skin graft in the same operation. The results obtained in the two groups were assessed with the Vancouver Scar Scale. Conclusions: Even though early excision followed by coverage with split-thickness skin graft remains the gold standard for the treatment of deep burns, enzymatic debridement can provide a series of advantages when the inclusion and exclusion criteria are respected. Bromelain is an alternative to surgical debridement that provides speed, tissue selectivity, safety, and less blood loss.


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