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O28.3 Suprathel versus autologous split-thickness skin in deep-partial-thickness burns
B U R N S 3 7 S (2011) S1 –S2 5
S19
Conclusion: Results of this review indicate that skin substitutes might have
Conclusion: Debridement of deep hand burns by a enzymatic agent can
some benefit over topical ointments in the treatment of facial burns regarding
significantly decreased the need for excisional debridement and skin graft
time to complete wound healing and pain. However, these results provide
coverage by preservation of viable tissue allowing spontaneous healing by
insufficient evidence to draw definite conclusions.
epithelialisation and releasing/preventing burn induced elevated tissue pressure.
O27.6
O28.3
The use of Versajet hydrosurgery: 5 years experience ∗
Suprathel versus autologous split-thickness skin in deep-partial-thickness burns
T. Anniboletti , M. Palombo, L. Fasciani, G. Delli Santi, P. Palombo. S. Eugenio Hospital, Roma, Italy
H.F. Selig ∗ . Medical University of Vienna, Vienna, Austria
Rationale: Early escharectomy and early skin grafting are the “Gold standard” in
Rationale: While autologous skin grafting has been the standard for coverage
the surgical treatment of burns however there are different methods available
of full-thickness areas, several options for deep-partial-thickness defects exist.
[1,2]. The Versajet hydrosurgery system (Smith & Nephew, London, UK) is
With regard to economize donor sites, we have compared a copolymer based
a device based on the Venturi effect [3], able to cut and aspirate debris
on DL-lactid acid (Suprathel® ) as temporary wound dressing with autologous
contemporarily. The aim of this work is to report our experience with the use of
skin, and analyzed time to healing and scar quality in matched areas of
Versajet® from july 2006 to now in 35 patients.
deep-partial-thickness burn wounds.
Methods: We analyzed a total of 35 patients (including 12 children) divided
Methods: We have recruited 18 patients with a median age of 45 years
into two homogeneous groups of 17 (Versajet) and 18 (escharectomy). Patients
(range: 25–83 years) for this prospective, non-blinded controlled noninferiority
were recruited and randomly assigned to Versajet or hand-held dermatome
trial suffering from deep-partial-thickness burns from November 2009 to July
escharectomy. As in previous studies we evaluated the time for complete
2010. After early tangential excision, matched deep-partial-thickness areas were
debridment and the efficacy of Versajet in reaching the correct dermal plane.
covered with 1:1.5 meshed autologous skin grafts and the copolymer for direct
Secondary end points were the assessment of postoperative pain (visual analog
intra-individual comparison. Scars were evaluated by means of the Vancouver
scale), adverse effects and complete healing times.
Scar Scale (VSS), the Patient and Observer Scar Assessment Scale (POSAS), and
Results: All of them received satisfactory debridment but the Versajet procedure
suction cutometry on days 30 and 90 postoperatively.
was faster (p=0,4), was more easy to reach the desirable plane and the healing
Results: Fifteen days after surgery, complete wound closure was present in 44.4%
time was shorter (on average about 7 days shorter).
(8/18) and 88.9% (16/18) of areas covered with the copolymer and autologous
Conclusions: The device is extremely versatile, the operator can regulate the
skin grafts, respectively. Scar evaluation detected similar results in areas covered
tissue excision made by the water jet adjusting its pressure, velocity and
with copolymer compared to autologous skin on days 30 (VSS: 3.8 vs. 4.9; Patient
modifying the hand piece direction. The final debridment is the same as the
Scar Assessment Scale: 14.1 vs. 20.0; Observer Scar Assessment Scale: 10.6 vs.
classic escaharectomy but it is faster, safer and more precise. In our experience
16.5) and 90 (VSS: 2.7 vs. 2.8; Patient Scar Assessment Scale: 14.0 vs. 17.6;
the Versajet System shows its benefits in the treatment of deep burns with a
Observer Scar Assessment Scale: 11.1 vs. 17.6) after surgery. Objectively assessed
soft eschara especially of difficult to treat areas like face, neck, lips, fingers,
viscoelastic parameter revealed comparable results in both study areas.
interdigital spaces, convex and concave areas.
Conclusion: Deep-partial-thickness burns covered with the copolymer exhibited
References:
a prolonged time to healing as compared to autologous skin grafts, while the
[1] Jeffery SL. Device related tangential excision in burns. Injury 2007 Dec;
scar quality as assessed by the VSS, POSAS and cutometry revealed comparable
38(Suppl 5):S35–8. [2] Granick M et al. Toward a common language: surgical wound bed preparation
results on days 30 and 90 after surgery. So far, our results seem promising and further long-term evaluation of scar quality after 6 and 12 months is ongoing.
and debridement. Wound Repair Regen 2006 May–Jun;14(Suppl 1):S1–10.
O28.4 O28.1
Objective color measurement on scars; reliability and validity of three
Enzymatic debridement of deeply burned hand: an update
instruments
Y. Krieger ∗ ,1 , D. Oz 2 , B. Berezovski 1 , E. Silberstein 2 , R. Gurfinkel 2 , O. Arnon 1 ,
M.B.A. Van der Wal ∗ , M.C.T. Bloemen, P.D.H.M. Verhaegen, P.P.M. Van Zuijlen,
D. Vigoda 1 , Y. Shoham 1 , N. Rosenberg 1 , A. Levi 1 , A. Sagi 1 , L. Rosenberg 1 .
E. Middelkoop. Red Cross Hospital, Beverwijk, Nederland
1
Soroka Medical Center, Beer-Sheva, Israel; 2 Ben-Gurion University, Beer-Sheva, Israel Rationale: Color measurement is an essential part of scar evaluation. Vascu-
Rationale: The burned hand is a common and difficult to care-for entity. Due
larisation (erythema) and pigmentation (melanin) are therefore very common
to the anatomy of the hand (important and delicate structures crowded in a
outcome parameters in scar research. The color of a scar can be assessed
small limited space without sub-dermal soft tissue), surgical debridement of the
subjectively with the use of a scar scale or objectively with a color measuring
burned tissue is technically difficult and may cause considerable complications.
device but preferably a combination of both. The Mexameter, Colorimeter and
A previous retrospective study have demonstrated the potential of an investi-
the DSMII are all color measuring devices. The purpose of this study was to
gational new Bromelain extract (NB) as fast, effective and selective enzymatic
investigate their clinimetric properties for scar evaluation.
debrider in reducing the secondary surgical debridement injury to the trauma-
Methods: Fifty scars with a mean age of 6 years (range 2 months–53 years) w
tized burned tissue and in maximizing spontaneous epithelialization.
ere included in this study. The different parameters of the instruments were
This study aims to continue and assess the implication of a selective enzymatic
tested for their reliability and validity. Reliability was determined by calculating
debrider (NB) in the special field of deep hand burns, by comparing it to control
the inter-observer Intra Class Coefficient (ICC). To determine validity, a Pearson
group of burned hands treated by Standard Of Care (SOC). Surgical intervention
correlation with the judgement of two experienced clinicians was calculated.
incidence, wound area surgically debrided and autografted and escharotomy
Results: All parameters of the three instruments obtained an inter-observer
incidence were the endpoints assessed.
ICC of ≥0.83 (CI: 0.71–0.90). The highest correlations with vascularisation scores
Material & Method: A prospective, randomized controlled Phase III trial as well
were: Mexameter: 0.59, Colorimeter: 0.69 en de DSMII: 0.66. For pigmentation,
as retrospective analysis of files of a previous study (Retro).
the highest correlations were: Mexameter: 0.75, Colorimeter: 0.54 en de DSMII:
Results: 31 NB and 41 SOC treated hands in the phase III study. Statistically
0.83.
significant decreased surgery, tangential excision and grafting were found in
Conclusion: Reliable data can be obtained with all three instruments. The DSMII
the 112 NB hands (31 new NB + 81 Retro) compared to the 41 SOC hands. No
shows the highest correlation with the findings of experienced clinicians. Based
escharotomy was performed in the NB group (0/112=0%) vs. 4 hands (4/41=9.7%)
on these results, the DSMII seems to be most appropriate color measuring
that were escharotomized in the SOC arm.
device for scar evaluation.
S19
Conclusion: Results of this review indicate that skin substitutes might have
Conclusion: Debridement of deep hand burns by a enzymatic agent can
some benefit over topical ointments in the treatment of facial burns regarding
significantly decreased the need for excisional debridement and skin graft
time to complete wound healing and pain. However, these results provide
coverage by preservation of viable tissue allowing spontaneous healing by
insufficient evidence to draw definite conclusions.
epithelialisation and releasing/preventing burn induced elevated tissue pressure.
O27.6
O28.3
The use of Versajet hydrosurgery: 5 years experience ∗
Suprathel versus autologous split-thickness skin in deep-partial-thickness burns
T. Anniboletti , M. Palombo, L. Fasciani, G. Delli Santi, P. Palombo. S. Eugenio Hospital, Roma, Italy
H.F. Selig ∗ . Medical University of Vienna, Vienna, Austria
Rationale: Early escharectomy and early skin grafting are the “Gold standard” in
Rationale: While autologous skin grafting has been the standard for coverage
the surgical treatment of burns however there are different methods available
of full-thickness areas, several options for deep-partial-thickness defects exist.
[1,2]. The Versajet hydrosurgery system (Smith & Nephew, London, UK) is
With regard to economize donor sites, we have compared a copolymer based
a device based on the Venturi effect [3], able to cut and aspirate debris
on DL-lactid acid (Suprathel® ) as temporary wound dressing with autologous
contemporarily. The aim of this work is to report our experience with the use of
skin, and analyzed time to healing and scar quality in matched areas of
Versajet® from july 2006 to now in 35 patients.
deep-partial-thickness burn wounds.
Methods: We analyzed a total of 35 patients (including 12 children) divided
Methods: We have recruited 18 patients with a median age of 45 years
into two homogeneous groups of 17 (Versajet) and 18 (escharectomy). Patients
(range: 25–83 years) for this prospective, non-blinded controlled noninferiority
were recruited and randomly assigned to Versajet or hand-held dermatome
trial suffering from deep-partial-thickness burns from November 2009 to July
escharectomy. As in previous studies we evaluated the time for complete
2010. After early tangential excision, matched deep-partial-thickness areas were
debridment and the efficacy of Versajet in reaching the correct dermal plane.
covered with 1:1.5 meshed autologous skin grafts and the copolymer for direct
Secondary end points were the assessment of postoperative pain (visual analog
intra-individual comparison. Scars were evaluated by means of the Vancouver
scale), adverse effects and complete healing times.
Scar Scale (VSS), the Patient and Observer Scar Assessment Scale (POSAS), and
Results: All of them received satisfactory debridment but the Versajet procedure
suction cutometry on days 30 and 90 postoperatively.
was faster (p=0,4), was more easy to reach the desirable plane and the healing
Results: Fifteen days after surgery, complete wound closure was present in 44.4%
time was shorter (on average about 7 days shorter).
(8/18) and 88.9% (16/18) of areas covered with the copolymer and autologous
Conclusions: The device is extremely versatile, the operator can regulate the
skin grafts, respectively. Scar evaluation detected similar results in areas covered
tissue excision made by the water jet adjusting its pressure, velocity and
with copolymer compared to autologous skin on days 30 (VSS: 3.8 vs. 4.9; Patient
modifying the hand piece direction. The final debridment is the same as the
Scar Assessment Scale: 14.1 vs. 20.0; Observer Scar Assessment Scale: 10.6 vs.
classic escaharectomy but it is faster, safer and more precise. In our experience
16.5) and 90 (VSS: 2.7 vs. 2.8; Patient Scar Assessment Scale: 14.0 vs. 17.6;
the Versajet System shows its benefits in the treatment of deep burns with a
Observer Scar Assessment Scale: 11.1 vs. 17.6) after surgery. Objectively assessed
soft eschara especially of difficult to treat areas like face, neck, lips, fingers,
viscoelastic parameter revealed comparable results in both study areas.
interdigital spaces, convex and concave areas.
Conclusion: Deep-partial-thickness burns covered with the copolymer exhibited
References:
a prolonged time to healing as compared to autologous skin grafts, while the
[1] Jeffery SL. Device related tangential excision in burns. Injury 2007 Dec;
scar quality as assessed by the VSS, POSAS and cutometry revealed comparable
38(Suppl 5):S35–8. [2] Granick M et al. Toward a common language: surgical wound bed preparation
results on days 30 and 90 after surgery. So far, our results seem promising and further long-term evaluation of scar quality after 6 and 12 months is ongoing.
and debridement. Wound Repair Regen 2006 May–Jun;14(Suppl 1):S1–10.
O28.4 O28.1
Objective color measurement on scars; reliability and validity of three
Enzymatic debridement of deeply burned hand: an update
instruments
Y. Krieger ∗ ,1 , D. Oz 2 , B. Berezovski 1 , E. Silberstein 2 , R. Gurfinkel 2 , O. Arnon 1 ,
M.B.A. Van der Wal ∗ , M.C.T. Bloemen, P.D.H.M. Verhaegen, P.P.M. Van Zuijlen,
D. Vigoda 1 , Y. Shoham 1 , N. Rosenberg 1 , A. Levi 1 , A. Sagi 1 , L. Rosenberg 1 .
E. Middelkoop. Red Cross Hospital, Beverwijk, Nederland
1
Soroka Medical Center, Beer-Sheva, Israel; 2 Ben-Gurion University, Beer-Sheva, Israel Rationale: Color measurement is an essential part of scar evaluation. Vascu-
Rationale: The burned hand is a common and difficult to care-for entity. Due
larisation (erythema) and pigmentation (melanin) are therefore very common
to the anatomy of the hand (important and delicate structures crowded in a
outcome parameters in scar research. The color of a scar can be assessed
small limited space without sub-dermal soft tissue), surgical debridement of the
subjectively with the use of a scar scale or objectively with a color measuring
burned tissue is technically difficult and may cause considerable complications.
device but preferably a combination of both. The Mexameter, Colorimeter and
A previous retrospective study have demonstrated the potential of an investi-
the DSMII are all color measuring devices. The purpose of this study was to
gational new Bromelain extract (NB) as fast, effective and selective enzymatic
investigate their clinimetric properties for scar evaluation.
debrider in reducing the secondary surgical debridement injury to the trauma-
Methods: Fifty scars with a mean age of 6 years (range 2 months–53 years) w
tized burned tissue and in maximizing spontaneous epithelialization.
ere included in this study. The different parameters of the instruments were
This study aims to continue and assess the implication of a selective enzymatic
tested for their reliability and validity. Reliability was determined by calculating
debrider (NB) in the special field of deep hand burns, by comparing it to control
the inter-observer Intra Class Coefficient (ICC). To determine validity, a Pearson
group of burned hands treated by Standard Of Care (SOC). Surgical intervention
correlation with the judgement of two experienced clinicians was calculated.
incidence, wound area surgically debrided and autografted and escharotomy
Results: All parameters of the three instruments obtained an inter-observer
incidence were the endpoints assessed.
ICC of ≥0.83 (CI: 0.71–0.90). The highest correlations with vascularisation scores
Material & Method: A prospective, randomized controlled Phase III trial as well
were: Mexameter: 0.59, Colorimeter: 0.69 en de DSMII: 0.66. For pigmentation,
as retrospective analysis of files of a previous study (Retro).
the highest correlations were: Mexameter: 0.75, Colorimeter: 0.54 en de DSMII:
Results: 31 NB and 41 SOC treated hands in the phase III study. Statistically
0.83.
significant decreased surgery, tangential excision and grafting were found in
Conclusion: Reliable data can be obtained with all three instruments. The DSMII
the 112 NB hands (31 new NB + 81 Retro) compared to the 41 SOC hands. No
shows the highest correlation with the findings of experienced clinicians. Based
escharotomy was performed in the NB group (0/112=0%) vs. 4 hands (4/41=9.7%)
on these results, the DSMII seems to be most appropriate color measuring
that were escharotomized in the SOC arm.
device for scar evaluation.