A Prospective Non Comparative Study on Efficacy and Safety of Enzymatic Burn Wound Debridement Using Bromelain Derived Debriding Agent Eschalyse

Rajkumar, M (2007) A Prospective Non Comparative Study on Efficacy and Safety of Enzymatic Burn Wound Debridement Using Bromelain Derived Debriding Agent Eschalyse. Masters thesis, Kilpauk Medical College, Chennai.

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Abstract

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 < 10% of total burn surface area. Burns covering 10 – 40% total burn surface area accounted for 32% of cases and burns covering >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.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Prospective Non Comparative Study ; Efficacy ; Safety ; Enzymatic Burn Wound Debridement ; Bromelain ; Debriding Agent Eschalyse.
Subjects: MEDICAL > Plastic and Reconstructive Surgery
Depositing User: Kambaraman B
Date Deposited: 12 Oct 2017 01:57
Last Modified: 12 Oct 2017 01:57
URI: http://repository-tnmgrmu.ac.in/id/eprint/3571

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