深度烧伤面部的酶促清创术：与传统手术清创相比，基于组织保存的愈合和早期瘢痕形成情况

Enzymatic debridement of deeply burned faces: Healing and early scarring based on tissue preservation compared to traditional surgical debridement.

作者信息

Schulz Alexandra, Fuchs Paul Christian, Rothermundt Irene, Hoffmann Alexandra, Rosenberg Lior, Shoham Yaron, Oberländer Henrik, Schiefer Jennifer

机构信息

Department of Plastic Surgery, Hand Surgery, Burn Center, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany.

出版信息

Burns. 2017 Sep;43(6):1233-1243. doi: 10.1016/j.burns.2017.02.016. Epub 2017 Mar 28.

DOI:10.1016/j.burns.2017.02.016

PMID:28363663

Abstract

INTRODUCTION

Facial burns occur frequently and depending on the injured skin layers often heal with scars which may cause permanent functional and cosmetic sequelae. Preservation of the sensitive facial skin layers, especially of the dermis is essential for scarless epithelialisation. Enzymatic debridement of deep thermal burns has already been shown to assist with preserving viable dermis. However, up to date, there are no published reports on wound healing and in the long term aesthetic outcome after enzymatic debridement of facial burns.

METHODS

Therefore we performed a-single centre clinical trial that included 26 subjects aged 18-78 years with facial burns clinically evaluated as deep dermal or deeper. Burns were treated either with enzymatic debridement or excisional surgical debridement. Then we compared both groups regarding debridement selectivity, wound closure and scar quality after more than 12 months.

RESULTS

Enzymatic debridement significantly reduced time to complete wound closure after admission (19.85 days versus 42.23 days, p=0.002), and after enzymatic eschar removal (18.92 days versus 35.62 days, p=0.042). The number of procedures to complete debridement were significantly lower in the enzymatic debridement group (1.00 versus 1.77, p=0.003). 77% of facial burns that had been debrided enzymatically were found to be more superficially burned than initially estimated. Wounds undergoing autografting of any size were significantly reduced by enzymatic debridement (15% versus 77%, p=0.002). Scar quality after enzymatic debridement was superior compared to surgical debridement after 12 months regarding pigmentation (p=0.016), thickness (p=0.16), relief (p=0.10), pliability (p=0.01), surface area (p=0.004), stiffness (p=0.023), thickness (0.011) and scar irregularity (p=0.011). Regarding erythema and melanin, viscoelasticity and pliability, trans-epidermal water loss or laser tissue oxygen saturation, haemoglobin level and microcirculation we found no significant differences for treated and untreated skin in the EDNX group.

CONCLUSION

In our current study we found Bromelain based enzymatic debridement better in some aspects of tissue preservation in deep dermal facial burn.

摘要

引言

面部烧伤很常见，根据受损皮肤层的不同，愈合后常伴有疤痕，可能导致永久性的功能和美容后遗症。保留面部敏感的皮肤层，尤其是真皮层，对于无疤痕上皮化至关重要。已有研究表明，酶解清创术有助于保留深Ⅱ度烧伤创面的存活真皮组织。然而，迄今为止，尚无关于面部烧伤酶解清创术后伤口愈合及长期美学效果的报道。

方法

因此，我们开展了一项单中心临床试验，纳入了26名年龄在18至78岁之间、临床评估为深Ⅱ度或更深程度面部烧伤的受试者。烧伤创面分别采用酶解清创术或手术切除清创术进行治疗。然后，我们比较了两组在清创选择性、伤口闭合情况及12个月后的疤痕质量。

结果

酶解清创术显著缩短了入院后完成伤口闭合的时间（19.85天对42.23天，p=0.002），以及酶解去除焦痂后的时间（18.92天对35.62天，p=0.042）。酶解清创组完成清创的操作次数显著更少（1.00对1.77，p=0.003）。经酶解清创的面部烧伤中，77%的创面烧伤深度比最初估计的更浅。酶解清创显著减少了接受任意大小自体皮移植的伤口数量（15%对77%，p=0.002）。在色素沉着（p=0.016）、厚度（p=0.16）、平整度（p=0.10）、柔韧性（p=0.01）、表面积（p=0.004）、硬度（p=0.023）、厚度（0.011）和疤痕不规则度（p=0.011）方面，酶解清创术后12个月的疤痕质量优于手术清创术后。在红斑和黑色素、粘弹性和柔韧性、经表皮水分流失或激光组织氧饱和度、血红蛋白水平及微循环方面，我们发现EDNX组中治疗和未治疗皮肤之间无显著差异。