Use of a selective enzymatic debridement agent(Nexobrid■)for wound management:Learning curve

• 作者: Bruce Patrik Dos Santos Jordi Serracanta Jorge Aguilera-Sáez Jose Manuel Collado Juan Pedro Barret Ricardo Palao
• 来源期刊: 世界皮肤病学杂志
• 学科: 医学
• 关键词: Burns ESCHAR DEBRIDEMENT ENZYMATIC DEBRIDEMENT Wound bed Nexobrid?Epithelialization DERMIS preservation AUTOGRAFT
• 年，卷（期）: 2017,（2）
• 页码范围: 32-41
• 页数: 10页
• 分类号: R

摘要

AIM To evaluate the efficacy of Nexobrid?in the initial management of burns and lessons learned with the procedure.METHODS From January 27th 2015 until January 25th 2016,25 patients aged between 18-94 years old with deep partial and full thickness burns were treated with Nexobrid?covering 1%-30%of their total body surface area(TBSA).The debridement was applied in the first 96 h post-injury following the protocol suggested for Nexobrid?.In patients with burns of more than 15%TBSA a second application of Nexobrid?was performed.After the removal of the product-4 h post application and after a 2 h period of wet dressing-we used several products to cover the wound like Suprathel?,Biobrane?,Mepitel?with wet dressing,silver sulphadiazine 1%cream,and in some cases even autografts.We treated patients with inhalation injury as well.All the procedures were done under deep sedation,regional blocks in extremities or general anaesthesia in the intensive care unit room or in the operating theatre.RESULTS After these first 25 cases,we have observed that patients with partial thickness burns treated with Nexobrid?,experienced great benefits in the reduction of the need for autografting compared with the standard of care.This is because after selective enzymatic debriding of the burn scar we can distinguish different wound beds,which can coexist in the same patient,and we also managed to associate each one to its ability to epithelize.In major burns,besides the improvement in wound healing,we observed an important improvement in their general state.This may be because SIRS significantly improved through a bloodless debridement of necrotic tissue,decreasing the requirements of vasoactive drugs and fluid resuscitation.Circumferential burns also benefited from enzymatic debridement,observing a decrease in the number of compartment syndromes and the need for escharotomies.At present,we have not observed a positive effect in the evolution and outcome of major burns with inhalation injury.CONCLUSION The introduction of Nexobrid?shows si