In the Department of Plastic Surgery, Hand Surgery, and Burn Center, University of Witten/Herdecke, Cologne-Merheim Medical Center, Cologne, Germany, Alexandra Schulz, MD, is a Senior Resident; Benedikt Ribitsch, MD, is a Resident; Paul Christian Fuchs, PhD, is Professor and Director; Alexandra Lipensky, MD, is a Resident; and Jennifer Lynn Schiefer, MD, is a Senior Resident. Acknowledgments: The NexoBrid product for enzymatic debridement has been approved for use in Germany and is currently an investigational product in a phase III controlled FDA trial in the United States. Dr Schulz has disclosed that she is a consultant for MediWound Ltd, although the current study was not funded by the product manufacturer. The authors have disclosed no other financial relationships related to this article. Submitted February 19, 2017; accepted in revised form August 3, 2017.
Adv Skin Wound Care. 2018 Jul;31(7):314-321. doi: 10.1097/01.ASW.0000532474.34841.d0.
Because genital burns are rare, only limited information on treatment guidelines is available in the literature. Vital tissue should be preserved to promote spontaneous healing because reconstruction does not always lead to satisfying results. The aim of this report is to present a general overview of current, prevailing treatment for genital burns and compare this to study authors' experiences. In addition, the article describes an entirely new approach of tissue-preserving bromelain-based enzymatic debridement of genital burn wounds.
This single-center study includes all patients who were treated for severe genital and perineal burn wounds at a burn intensive care unit between December 1995 and December 2016. A review of literature was performed in PubMed covering the years 1990 to 2016.
A total of 149 patients were admitted with severe burns or scalding of the genitals or the perineum. As in the majority of cases reported in the current literature, most of these patients were treated conservatively. When there was demarcation of necrotic tissue, tangential excision and skin grafting were performed, and since 2015, 3 patients admitted to this facility have been treated with bromelain-based debridement followed by spontaneous healing. Certain small-scale studies in the literature describe a disproportionate number of surgical interventions.
Based on this evidence, study authors support a conservative view of genital burn treatment. Enzymatic debridement allows earlier and more selective debridement, which can improve the aesthetic outcome.
由于生殖器烧伤较为罕见，因此文献中仅有有限的治疗指南信息。应保存重要组织以促进自然愈合，因为重建并不总是能带来满意的结果。本报告旨在概述目前流行的生殖器烧伤治疗方法，并将其与研究作者的经验进行比较。此外，本文还介绍了一种全新的保留组织的方法，即使用菠萝蛋白酶进行生殖器烧伤创面的酶性清创。
本单中心研究纳入了 1995 年 12 月至 2016 年 12 月期间在烧伤重症监护病房接受严重生殖器和会阴烧伤治疗的所有患者。在 PubMed 中检索了 1990 年至 2016 年的文献。
共有 149 名患者因生殖器或会阴严重烧伤或烫伤而入院。与当前文献中报告的大多数病例一样，这些患者中的大多数接受了保守治疗。当出现坏死组织分界时，进行切线切除和植皮术，自 2015 年以来，本机构收治的 3 名患者接受了基于菠萝蛋白酶的清创术，随后自然愈合。文献中的某些小规模研究描述了不成比例数量的手术干预。
基于这些证据，研究作者支持对生殖器烧伤治疗持保守观点。酶性清创术可以更早、更有选择性地进行清创，从而改善美观效果。
