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

作     者：Ricardo Palao Jorge Aguilera-Sáez Jordi Serracanta Jose Manuel Collado Bruce Patrik Dos Santos Juan Pedro Barret 

作者机构：PlasticReconstructive and Burns Unit ServiceVall d'Hebron University Hospital 

出 版 物：《World Journal of Dermatology》 (世界皮肤病学杂志)

年 卷 期：2017年第6卷第2期

页      面：32-41页

学科分类：10[医学] 

主　　题：Burns Eschar Debridement Enzymatic debridement Wound bed Nexobrid■ Epithelialization Dermis preservation Autograft 

摘      要：AIM To evaluate the efficacy of Nexobrid~? in the initial management of burns and lessons learned with the *** From January 27^(th) 2015 until January 25^(th) 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 *** 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 isbecause 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 o