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

Schulz, Alexandra; Perbix, Walter; Shoham, Yaron; Daali, S.; Charalampaki, Cleopatra; Fuchs, Paul Christian; Schiefer, Jennifer Lynn

doi:10.1016/j.burns.2016.08.009

Cited by 64 publications

(35 citation statements)

References 41 publications

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“…Schulz et al . [14] Partial Rosenberg et al . [4] To provide detailed user-orientated guidelines and recommendations based on available literature as well as on the growing amount of experience with ED in Europe, a European Consensus Workshop was held in January 2017.…”

Section: Discussionmentioning

confidence: 99%

“…After ED, the burn wound is vulnerable and needs to be protected against wound infection and desiccation by a suitable dressing. Some authors report the use of epidermal substitutes like Suprathel or even allografts to cover the wound bed after ED in order to promote spontaneous reepithelization without instable scar-ring [14] , while other authors prefer conventional antiadhesive wound dressings with polyhexanide gel [7] . If wound bed assessment indicates a deep dermal wound with expected prolonged healing time or instable scarring, early surgical coverage -eventually accompanied by additional debridement -by split-thickness skin grafting (STSG) should be considered.…”

Section: Post Treatmentmentioning

confidence: 99%

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State of the art in enzymatic debridement

Ziegler¹,

Hundeshagen²,

Cordts³

et al. 2018

PAR

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Surgical treatment of deep partial thickness to full thickness burn wounds by knife has been the undisputed standard of care and was one key point in surgical burn medicine for decades. Recently, it gets more and more challenged by Bromelain-based enzymatic burn wound debridement (ED) as technique for non-surgical, selective eschar removal. Although the literature on ED is increasing constantly it cannot comprise the rapid progress that is made in clinical application of ED. To outline the current state of art in ED, recent literature as well as clinical experience is summarized and the main steps in clinical application including indications, wound preparation, application of the enzyme, wound bed assessment and further treatment after ED are discussed. Initial indications and limitations in application of ED could be gradually extended to increase versatility of ED as tool in burn surgery. Several randomized controlled trials compared ED to standard of care (SOC). They could show significant shorter time to complete burn wound debridement and wound closure, reduced need for surgery, reduced blood loss, reduced area of burns that needed surgical excision and need for autograft as well as an improved scar quality. Further research is necessary to justify an extensive use of ED as tool for burn eschar removal. Especially a robust comparison to surgical burn wound excision by knife as SOC is required to facilitate evidence-based burn surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Post Treatmentmentioning

confidence: 99%

State of the art in enzymatic debridement

Ziegler¹,

Hundeshagen²,

Cordts³

et al. 2018

PAR

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“…When applying NexoBrid ® the number and area of donor sites may decrease resulting in a reduced scarring. This is of considerable importanceinviewoflifequality [6,7,9].Anapplicationadvantage is seen in the treatment of extremities burns, e. g. hand and feet burns and in the face because NexoBrid ® simplifiesdebridement andhasthepowertopreservemoreviabledermis [13,15,16].At least conservation of dermal structures using NexoBrid ® favours reepithelialisation and thereby ensures higher quality of life to burn patients. Moreover NexoBrid ® improves propaedeutic diagnostics of post-debridement procedures at an early time point of therapy.…”

Section: Discussionmentioning

confidence: 99%

Enzymatic burn wound debridement with NexoBrid®: Cost simulations and investigations on cost efficiency

Kern¹,

Depka²,

Schackert³

et al. 2017

Gesundh ökon Qual manag

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Aim Removal of eschar (debridement) is an essential and early step in the treatment of deep burns. Enzymatic debridement by NexoBrid® is a relatively new non-surgical tool for early, individualized and selective debridement which adds some advantages compared to surgical standard techniques known as standard of care (SOC). Nevertheless, until now it is not represented and calculated in the pricing system for German hospitals (G-DRG system), and an own operative procedure key (OPS) is lacking. The objective of this empiric cost study was to compare treatment cost of enzymatic debridement by NexoBrid® and SOC based procedures and to analyse the impact of improved burn wound care using NexoBrid® on total treatment costs of burn patients. Method The analysis is based on two different cost simulation models, the Average Outcome Model and the Defined Patient Model. Based on the results of a randomized phase III trial and treatment costs specified in the pricing system for German hospitals (G-DRG system), total costs of NexoBrid® based treatments were compared to those of SOC to determine cost saving potentials (Average outcome model). In addition, distinct burn wound treatment pathways common in clinical practice were assigned to actual treatment costs to allow economic considerations (Defined Patient Model). Results Using NexoBrid® cost savings are inversely related to the treated total burned surface area (1–15% TBSA) and directly related to the savings in burn centre stay (up to 6.5 days) (Average Outcome Model). Based on quantitative and qualitative aspects, three quarter of all cases in the range of 5% to 15% TBSA burned are in favour of NexoBrid®. Main cost drivers are LOS and ICU stay (45–80% of total costs). NexoBrid® becomes a more powerful cost driver with increasing TBSA treated. If NexoBrid® completely substitutes for SOC, the total cost per patient can be reduced by nearly 30% (treatment of 5% TBSA) or are in the range of SOC costs (treatment of 15% TBSA) (Defined Patient Model). Highest costs are generated when enzymatic and surgical methods for debridement are combined and an increased LOS or ICU stay is indicated. Conclusion Cost advantages of enzymatic debridement by NexoBrid® may emerge in cases with low or medium burned and treated surface area when costs for enzymatic debridement remain below the costs for SOC (excision plus autografting). Even in more severe cases (15% TBSA burned) total costs of basic NexoBrid®-based treatment pathways do not exceed costs of comparable SOC pathways. In addition, enzymatic debridement by NexoBrid® can be successfully applied as a strategic tool in order to reduce surgical procedure time and OR room capacity and making use of the redundant capacity for further surgical cases reimbursement. Beside these quantitative aspects that may improve overall economic efficiency, qualitative improvements of burn wound care must be considered separately from this analysis.

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“…Die Methode erfordert viel Erfahrung und sollte spezialisierten Verbrennungszentren vorbehalten bleiben. Neben der Indikationsstellung stellt vor allem die Interpretation des Wundgrundes und die darauf basierende Auswahl der im Anschluss an das Debridement durchzuführenden Wundbehandlung hohe Anforderungen [13]. Auch bei zirkulär tiefdermalen Verbrennungen stellt das ED eine Alternative zur Vermeidung einer Escharotomie dar.…”

Section: Diskussionunclassified

Möglichkeiten und Grenzen der enzymatischen Lokaltherapie von Handverbrennungen

Billner

Promny²,

Reichert³

2019

Handchir Mikrochir plast Chir

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ZusammenfassungBei Verbrennungsverletzungen spielen die Hände aufgrund ihrer Exposition und der durch tiefdermale Schädigungen der Haut entstehenden funktionellen sowie ästhetischen Einschränkungen eine besondere Rolle. Durch die Einführung des enzymatischen, Bromelain basierten Wunddebridements wurde eine alternative Behandlungsmethode zur Frühexzision von Verbrennungen geschaffen. Dargestellt und diskutiert wird der Verlauf von drei Fällen mit enzymatischer Behandlung bei tiefdermalen Verbrennungen an den Händen.

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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

Cited by 64 publications

References 41 publications

State of the art in enzymatic debridement

State of the art in enzymatic debridement

Enzymatic burn wound debridement with NexoBrid®: Cost simulations and investigations on cost efficiency

Möglichkeiten und Grenzen der enzymatischen Lokaltherapie von Handverbrennungen

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