Osinga Rik, Steiger Peter, Giovanoli Pietro, Plock Jan A, Mannil Lijo
Klinik für Plastische Chirurgie und Handchirurgie, Zentrum für Brandverletzte, UniversitätsSpital Zürich.
Klinik für Plastische, Rekonstruktive, Ästhetische und Handchirurgie, Universitätsspital Basel.
Handchir Mikrochir Plast Chir. 2019 Apr;51(2):80-85. doi: 10.1055/s-0044-100613. Epub 2018 Apr 26.
Thermal injuries are frequent and can be associated with relevant morbidity and mortality in severe cases. Excisional debridement followed by autografting is the standard of care for deep burns, but is associated with serious potential complications. Clinical results of a novel enzymatic debridement based on Bromelain raw material extracted from the pineapple plant (Nexobrid™) were published in 2014. At the Center for Burns at the University Hospital Zürich enzymatic debridement was introduced in 2016. Our experience and interpretation of the first 12 cases are reported.
Patients of at least 18 years of age with second and third degree burns were included in this study. Pregnant or breast feeding women were excluded. After so-called "pre-soaking" with saline solution, the Nexobrid™ gel was applied for 4 hours with occlusive sealing. After abrasion of the debris, "post-soaking" with Prontosan followed and definite wound dressings were applied.
The mean age of the patients was 51 (19-78) years, the length of hospital stay was 38 (1-92) days. The amount of burns was 25 (1-67) % of the total body surface area (TBSA). On average, 11 (1-18) % of the TBSA was debrided with Nexobrid™ after 7 (1-19) days. In 8 patients, the defects completely healed without scarring after Nexobrid™ treatment. In 4 patients additional surgical measures were necessary to complete the debridement as well as to cover the defect. The treatment with Nexobrid™ was efficient in difficult treatment areas such as back, hands and feet, where preservation of the demis prevented joint contracture through scarring.
Treatment with Nexobrid™ extends the armamentarium to treat partial second-degree thermal injuries with good long-term results. It can be applied in analgosedation in an intensive care setting and reduces the need for surgical treatment.
热损伤很常见，严重时可导致相关的发病率和死亡率。切除清创后进行自体植皮是深度烧伤的标准治疗方法，但会伴有严重的潜在并发症。2014年公布了一种基于从菠萝植物中提取的菠萝蛋白酶原料（Nexobrid™）的新型酶促清创术的临床结果。2016年，苏黎世大学医院烧伤中心引入了酶促清创术。本文报告了我们对前12例病例的经验和解读。
本研究纳入了年龄至少18岁的二度和三度烧伤患者。排除孕妇或哺乳期妇女。用盐溶液进行所谓的“预浸泡”后，涂抹Nexobrid™凝胶4小时并封闭包扎。清除碎片后，接着用Prontosan进行“后浸泡”，并应用确定性伤口敷料。
患者的平均年龄为51（19 - 78）岁，住院时间为38（1 - 92）天。烧伤面积占总体表面积（TBSA）的25（1 - 67）%。平均而言，7（1 - 19）天后，用Nexobrid™清创的面积占TBSA的11（1 - 18）%。8例患者经Nexobrid™治疗后缺损完全愈合且无瘢痕形成。4例患者需要额外的手术措施来完成清创以及覆盖缺损。Nexobrid™治疗在背部、手部和足部等难以治疗的部位有效，在这些部位保留真皮可防止因瘢痕形成导致关节挛缩。
Nexobrid™治疗扩展了治疗部分二度热损伤的手段，长期效果良好。它可用于重症监护环境下的镇痛镇静，并减少手术治疗的需求。
