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Ziegler B, Fischer S, Pieper D, Mathes T, Kneser U, Hirche C. Evidence and Trends in Burn Wound Debridement: An Evidence Map. Plast Surg (Oakv) 2020; 28:232-242. [PMID: 33215038 DOI: 10.1177/2292550320928553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Treatment of the burn wound is crucial in care of severely burned patients. Surgical strategies differ in technique and timing of wound excision and are considered to have an impact on morbidity and mortality of burn patients. Most techniques and strategies have been established during the last century and are still standard of care. Nonetheless, several newer techniques have been presented and evaluated recently. To summarize the evidence and trends for eschar removal by burn wound debridement currently available, an evidence map as variant of the systematic review, was prepared. For this purpose, a systematic literature search was performed in the PubMed databases until December 2016. While overall evidence in this domain is low, recent publications focus on optimal timing of wound excision, enzymatic debridement, and hydrosurgery. Several studies report the benefit of an early wound excision in terms of shorter hospital stay, lower wound infection rate, and reduction of postburn metabolic changes. Enzymatic debridement has been shown to be an effective tool for early eschar removal and in addition reduces the need for autografting of the debrided burn wound with a relatively high level of evidence (LoE 2-). Wound debridement by means of hydrosurgery is more precise compared to conventional wound excision and preserves viable dermis, but a positive effect on wound healing or scar formation could not been shown (LoE 2). Furthermore, rarely reported techniques comprise larvae therapy, debridement by laser, and other technical adjuncts, but the level of evidence is limited (LoE 4-/5).
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Affiliation(s)
- Benjamin Ziegler
- Department of Hand, Plastic and Reconstructive Surgery - Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Heidelberg, Germany
| | - Sebastian Fischer
- Department of Hand, Plastic and Reconstructive Surgery - Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Heidelberg, Germany
| | - Dawid Pieper
- Department for Evidence Based Health Service Research, Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Tim Mathes
- Department for Evidence Based Health Service Research, Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery - Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Heidelberg, Germany
| | - Christoph Hirche
- Department of Hand, Plastic and Reconstructive Surgery - Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Heidelberg, Germany
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Díaz-Molina C, Cases-Perera O, Lara-García FJ. Razor wound debridement: A new tool for wound bed preparation. J Plast Reconstr Aesthet Surg 2019; 72:e15-e16. [PMID: 30880048 DOI: 10.1016/j.bjps.2019.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Cristóbal Díaz-Molina
- Department of Plastic and Reconstructive Surgery, Hospital Virgen de las Nieves, Avda. Juan Pablo II s/n, 18013 Granada, Spain.
| | - Oriol Cases-Perera
- Department of Plastic and Reconstructive Surgery, Hospital Virgen de las Nieves, Avda. Juan Pablo II s/n, 18013 Granada, Spain
| | - Francisco J Lara-García
- Department of Plastic and Reconstructive Surgery, Hospital Virgen de las Nieves, Avda. Juan Pablo II s/n, 18013 Granada, Spain
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Hirche C, Citterio A, Hoeksema H, Koller J, Lehner M, Martinez JR, Monstrey S, Murray A, Plock JA, Sander F, Schulz A, Ziegler B, Kneser U. Eschar removal by bromelain based enzymatic debridement (Nexobrid ® ) in burns: An European consensus. Burns 2017; 43:1640-1653. [DOI: 10.1016/j.burns.2017.07.025] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/22/2017] [Accepted: 07/27/2017] [Indexed: 10/18/2022]
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