INTRODUCTION
One of the major characteristics of burns is the formation of an
eschar, which is made up burned and traumatized tissue. The presence of
the eschar that covers the entire injured area prevents accurate diagnosis
of the burns depth and may lead to the extension of injury to neighboring,
originally undamaged tissues. The eschar also serves as a medium for
bacterial growth, and is therefore a source of infection, contamination and
sepsis. As a result, prompt removal of the eschar is imperative to the
healing of burns.
The current method of choice for burn debridement is surgical
tangential excision as advocated by Janzekovic in 1970. While effective,
surgical debridement has several major disadvantages. Tangential
excision is non-selective and may sacrifice healthy surrounding tissues,
often converting a partial thickness burn into a full thickness defect.
Furthermore, surgical excision is painful and exposes patients to the risks
of repeated anesthesia and significant bleeding. Enzymatic debridement
has been suggested in the past, however the agents used have had several
drawbacks. In particular, most enzymatic agents require prolonged and
repeated exposures in order to achieve sufficient debridement often
necessitating further surgical or chemical debridement. Furthermore,
repeated application, especially when using moist occlusive dressings for
extensive periods of time, may result in local infection and promote
systemic spread of the infectious process.
AIM OF THE STUDY:
The aim of the current study was to evaluate the efficacy of burn
wound debridement using the Eschalyse enzyme preparation as well as to
evaluate its
1. Safety : ie without any systemic and local adverse effects.
2. Slectivity : resulting in removal of the necrotic eschar without affecting the surrounding viable tissue.
3. Effectiveness : remove the entire eschar preferably in a single application.
4. Rapidity : resulting in rapid reduction of the infection risk and permitting sequential debridement of large areas over a short time span.
5. Simple to use and cost effective.
MATERIALS AND METHODS:
Place of Study - This is a prospective, non-comparative study involving 25 patients
both mate and female admitted to the burn unit, Department of Burns,
Plastic and Reconstructive Surgery, Kilpauk Medical College,Chennai.
Period of Study - Jun 2005 – December 2006.
Study Group - 25 patients both male and female of age group 15 years to 50years
with burns of total body surface area of 10-40% were included in the
study. These patients had burns ranging firm second degree deep to fall
thickness burns.
Criteria: 1. Patients were excluded in the presence of severe smoke inhalation, a recent history of myocardial infarction, concurrent acute injury (or) disease that might compromise the patient’s life or welfare. Significant hematological, cardiovascular, hepatic (or) neoplastic disease or other immediate life threatening conditions.
2. Patients were also excluded if they had poorly controlled diabates mellitus, a history of allergy atopic disease or known sensitivity to pineapple (or) were pregnant (or) nursing.
3. Pre and post application investigations like TC, Hemoglobin, liver function tests like SGOT, SGPT, SAP, Serum creatinin were done to rule out any adverse effect.
RESULTS: Our study include mainly patients between ages 20 – 40 years.
Children were excluded because of ethical reasons. There was a slight preponderance towards male 15 Males (60%) , 10 Females (40%). Most of our enzyme application was done in flame burns 16cases(64%) and Scalds 7cases (28%) and we have not applied in
electrical burn involving the limbs and the flash burns was included in flame burns itself and here the contact burns 2 cases (8%) implies to acid burns. Most burns 64% covered 40% total burn surface area accounted for 4% of cases. 15 cases (60%) of them were of mixed type, 8 cases (32%) of them were Deep, 2 cases (8%) of them were full thickness.
Distribution of Burns: Upper limb - 14 case (56%), Trunk - 5 case (20%),
Lower limb - 4 case (16%), Neck - 2 case (8%). No. of Applications:
Single Application - 7 cases 28%, Two Applications - 12 cases 48%, Three Applications - 6 cases 24%. Percentage of Debridement: After 1st Application - 70 - 80%,
After 2nd Applications - 80 - 90%.
CONCLUSIONS:
On analyzing our result we achieved debridement with single
application in 28% of cases, and two applications in 48% of cases
and three applications in 24% of cases.
* Percentage of debridement achieved with single application is 70±
10% and after two applications we achieved 80±10% and after 3
applications we achieved around 95 ± 5%.
* Approximately one quarter of the burns were completely debrided
with in one or two days and another half complete debridement
with in 3-4 days and in some extensive burns sequential application
helps us to achieve the debridemnet in a short time.
* In all cases where enzymatic debridement with eschalyse was
complete, skin allografting, for biological, epithelialization
enhancing cover or other topical covers were performed at the
bedside with minimal pain and no bleeding.
* In cases of full thickness burns and an excellent eschalyse
debridement the grafting of an autograft could be done without
further surgical debridement and without the repeated blood
transfusions in case of repeated surgery and furthur grafting the
recipient bed prepared by scraping or dermabrasion. This is
obviously of great benefit when compared to the pain and bleeding
associated with surgical debridement and the patient not subjected
to repeated anesthesia.
* The selectivity of the preparation was demonstrated by the lack of
effect on the healthy surrounding tissue and the preservation of
remnants of unburned tissues (dermis and epidermis). Finally,
unlike other non surgical debridement techniques, eschalyse
achieved a thorough debridement in a single or double application
offering a rapid and selective burn wound debridement method
* Total duration of stay in the hospital were drastically reduced and
seems to be very cost effective.
* Psychological and rehabilitative part on behalf of the patient
remains easy.
* Fever, localized pain and burning sensation were observed as side
effects and managed appropriately. No specific morbidity and
mortality noted.
* To conclude the availability of a rapid, reliable and complication
free enzymatic debriding agent may open new horizons and
provide a new treatment modality for burn wound management
