China
Africa
Explore chapters and articles related to this topic
Wound care
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Selective debridement Surgical (some would put this in the non-selective category). This is the most common method and involves blades/curettes, etc.; some use more complicated systems such as the Versajet®.Enzymatic – selectively digest dead tissue/slough. Iruxol Mono® is a collagenase, clostridiopeptidase A, but takes several days to work. Others such as Nexobrid® (bromelain, derived from pineapple stems) may work quicker (Rosenberg L, Burns, 2004) but is not widely available.Autolytic – the combination of moist dressings, e.g. hydrocolloids and endogenous proteolytic enzymes, can lead to the liquefaction of necrotic tissue that then separates. It can be enhanced with hydrocolloids/hydrogels/occlusive films and products such as medical honey.Biological – maggots of certain species, e.g. Lucilia sericata, can cause benign myiasis, i.e. the larvae only digest dead tissue, extracorporeally through chymotrypsin-like enzymes (note that some species cause malignant myiasis, damaging healthy tissue). There are reports of an antimicrobial action and promotion of healing. There may be pain after 2–3 days, supposedly due to alkaline secretions, whilst other secretions may cause irritation/excoriation of normal skin Maggots have been used in military wounds for a long time. Crile demonstrated that soldiers with maggot-infested wounds actually did better. Following the increasing use of antibiotics, maggot therapy declined, but it has had a resurgence since the 1980s. In the United Kingdom, they can be prescribed and used in the community. They are useful in infected necrotic wounds including diabetic ulcers and pressure sores, particularly those unfit for surgery. One study showed healing of 90% of MRSA-infected wounds after one to two maggot applications over 4–6 days.Maggots take 10–14 days to pupate, requiring a dry place; thus, it is important to keep them in the wound and to dispose of them quickly.
The process to obtain reimbursement for enzymatic debridement in clinically deep burns
Published in Acta Chirurgica Belgica, 2023
Karel Claes, Henk Hoeksema, Cynthia Lafaire, Lieve De Cuyper, Katrien De Groote, Tom Vyncke, Ignace De Decker, Jozef Verbelen, Petra De Coninck, Bernard Depypere, Stan Monstrey
Efficacy can be defined as the performance of an intervention under ideal and controlled circumstances, whereas effectiveness refers to its performance under ‘real-world’ conditions [24]. The benefits of NexoBrid® treatment in terms of effectiveness were demonstrated by the results of the patient registry that collected data from daily practice in 2 Belgian burn centers from 1 March 2016 to July 2018. When assessing the proportion of burn wounds with successful debridement, EDNX treatment showed an overall success rate of 95.1% (39/41 patients) within the approved indication in the Belgian registry. After closing the first registry, 16 additional patients were treated with NexoBrid® at Ghent University Hospital between August 2018 and the submission of the P&R dossier in April 2019. Of these patients, 81.2% demonstrated complete eschar removal after EDNX treatment and 18.8% had excellent debridement, resulting in a 100% success rate for this additional group of patients. These results were comparable to the success rate of the DETECT study (96.3%) [23] and better than the RCT of Rosenberg et al. with a success rate of 93.2% [10]. It should be noted that there were no treatment failures in the last 43 patients of the registry. Treatment failure only occurred at the start of the first treatments, indicating that both burn centers had gone through a learning curve as described in recent publications, resulting in achieving consistently good effectiveness results.
Enzymatic debridement: past, present, and future
Published in Acta Chirurgica Belgica, 2022
Ignace De Decker, Liesl De Graeve, Henk Hoeksema, Stan Monstrey, Jozef Verbelen, Petra De Coninck, Els Vanlerberghe, Karel E. Y. Claes
Although tangential excision remains the gold standard in the majority of burns facilities worldwide, there is increasing evidence that bedside administered NexoBrid®, preferably under regional anesthesia, is a powerful tool to selectively remove the burn eschar resulting in reduced blood loss and a reduced need for autologous skin grafting compared to the surgical SOC. However, the clinical wound bed evaluation post-NexoBrid® procedure in relation to the optimal treatment decision—conservative treatment vs. surgery—is not yet completely elucidated. More high-quality prospective clinical trials are necessary to compare enzymatic debridement of objectively confirmed deep burns with the current standard treatment and assess the effectiveness of the eschar removal, the need for surgery, the healing time of such wounds, and the long-term scar quality.
Enzymatic debridement of hands with deep burns: a single center experience in the treatment of 52 hands
Published in Journal of Plastic Surgery and Hand Surgery, 2020
Mehran Dadras, Johannes M. Wagner, Christoph Wallner, Alexander Sogorski, Maxi Sacher, Kamran Harati, Marcus Lehnhardt, Björn Behr
We did not find an impact of the timing of Nexobrid application within the recommended 72 h timeframe. Here, sufficient soaking and achieval of a moist wound bed are fundamental for the success of enzymatic debridemend as has been described in the European consensus paper [8]. Analogously to the finding of Schulz et al. in the description of their learning curve, we estimated exudation immediately after enzymatic debridement or after 2 h soaking too excessive for definite wound coverage [5]. Therefore we initiated antiseptic dressings with polyhexanide gel at least over night before definite wound coverage with Suprathel, foam dressings or skin grafts was performed. This is in accordance with the European consensus on Nexobrid treatment, where skin grafting is recommended not earlier than 2 days after debridement [8]. 4 out of 14 full thickness burns and 8 out of 38 deep partial thickness burn wounds received complementary surgical excision after the enzymatic process prior to skin grafting. The need for surgical excision was determined by the senior surgeon and it’s hardly possible to discuss it in retrospective. However, if split thickness skin grafting was planned, the threshold to perform additional surgical excision was low to avoid graft loss and further healing delay.