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Bromelain based debridement agent: introduction to our daily practise, modifications to the standard protocol and post-debridement wound dressing

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Introduction: In modern burn therapy an optimal debridement must be effective, fast and safe. At present, surgical excision followed by autografting is the standard of care (SOC) for deep burns. However, invasive surgery often results in loss of viable tissue, blood and heat. We present an early single center experience with a new Bromelain Based Debridement agent (BBD). Methods: From May 2015 to May 2017, we treated 62 patients aged between 18-79 years suffering from deep partial and full thickness thermal burns with TBSA no more than 20%. BBD application was performed at the patient’s bedside under IV analgesia while BBD removal was performed in the operating theatre under analgo-sedation. We modified the standard protocol of BBD application and immediate post-debridement wound dressing. After eschar removal, full thickness burns were autografted, while viable dermis and mixed wounds were treated with UrgoClean®, Suprathel® or fatty gauze. A retrospective analysis of patients treated with conservative dressings was conducted to evaluate time to wound healing, pain scores, and number of dressing changes. The pain scores were obtained during dressing changes using the visual analog pain scale 1–10; 0 being no pain, 5 being moderate pain, and 10, the severe pain. Results: We treated 62 patients with deep partial and full thickness thermal burns, 37 male and 25 female, aged 18-79 . The mean TBSA treated was 7.1% (range 3-20%). 19 patients were autografted, 43 patients were treated with fatty gauze, Suprathel® or UrgoClean®. The mean age of patients in Urgoclean group was 39.3 years, in Suprathel group was 41.5 years while in fatty gauze group the mean age was 48.7 years. The mean TBSA treated was 7.9 % in Urgoclean group, 7.2 % in Suprathel group, while the mean TBSA treated was 8.3 % in the fatty gauze group. The anatomic areas involved in Urgoclean group were head/neck 2%, upper extremities 39%, torso 27% and lower extremities 32%. The anatomic areas involved in Suprathel group were head/neck 5%, upper extremities 49%, torso 18% and lower extremities 28%.The anatomic areas involved in fatty gauze group were head/neck 2%, upper extremities 20%, torso 48% and lower extremities 30%. The average healing time was 15 days for the Urgoclean patients, 17 days for the Suprathel patients and 19 days for the fatty gauze patients. The average pain scores was 1.8 for Urgoclean treated group, 2.2 for Suprathel treated group and 6.9 for fatty gauze treated group. The number of wound dressing changes was 1.9 in Urgoclean treated group, 2.3 in Suprathel treated group and 8.3 in fatty gauze group. Conclusions: In our experience, BBD proved to be an effective, fast and selective therapeutic tool for burn wound management. Our modifications to the standard protocol made BBD application easier and more practical and allowed a more effective eschar removal. Our data regarding the use of Urgoclean, Suprathel and fatty gauze in the post-enzymatic debridement wound dressing suggest that all three dressings were effective managing partial-thickness and deep partial-thickness burn wounds. Time to wound healing was similar among the three treatment groups. However, the treatment profiles differed partially with a limited number of wound dressing changes and lower pain scores for the Urgoclean and Suprathel groups compared with the fatty gauze group.

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© Copyright 2020 Morressier GmbH.
All rights reserved.