Débridement von Verbrennungswunden - Nutzen und Möglichkeiten

Zusammenfassung

Das Débridement beziehungsweise die Nekrektomie der Verbrennungswunde beschreibt die Abtragung avitaler Anteile der Haut. Durch das Débridement wird die Freisetzung von Toxinen aus der verbrannten Haut verhindert, und bei infizierten Verbrennungswunden wird die bakterielle Last gesenkt. Das Débridement senkt damit die Morbidität und Mortalität. Die tangentiale Nekrektomie wird klassischerweise mit dem Humby- oder Goulian-Messer ausgeführt. Enzymatische Salben und Wasserstrahlgeräte stellen weitere Therapieverfahren für das Débridement dar.

Abstract

Debridement describes the removal of devitalised tissue and debris (to reduce the toxic and bacterial burden) from a wound. In thermally injured tissue, the adoption of excisional strategies has been shown to improve both morbidity as well as mortality, albeit at the expense of creating new donor wounds. Tangential debridement is performed with surgical steel (i.e., Humby or Goulian knife). Other modalities like enzymatic ointments and hydrosurgical systems have shown promise in refining the debridement process, affording a measure of control with respect to the depth of debridement.

Schlüsselwörter

Débridement - Verbrennung

Key words

debridement - burns

Literatur

• 1 Aldea P A, Shaw W W. The evolution of surgical management of severe lower extremity trauma.  Clin Plast Surg. 1986;  134 549-569
• 2 Allgöwer M, Cueni L B, Stadtler K, Schoenenberger G A. Burn toxin in mouse skin.  J Trauma. 1973;  13 95-111
• 3 Al-Qattan M M. Surgical management of post-burn skin dyspigmentation of the upper limb.  Burns. 2000;  26 581-586
• 4 Amani H, Dougherty W R, Blome-Eberwein S. Use of Transcyte and dermabrasion to treat burns reduces length of stay in burns of all size and etiology.  Burns. 2006;  32 828-832
• 5 Bishop J F. Burn wound assessment and surgical management.  Crit Care Nurs Clin North Am. 2004;  16 145-177
• 6 Botha A J, Moore F A, Moore E E, Kim F J, Banerjee A, Peterson V M. Postinjury neutrophil priming and activation: an early vulnerable window.  Surgery. 1995;  118 358-364
• 7 Burke J F, Bondoc C C, Quinby W C. Primary burn excision and immediate grafting: a method shortening illness.  J Trauma. 1974;  14 389-395
• 8 Caldwell Jr F T, Wallace B H, Cone J B. Sequential excision and grafting of the burn injuries of 1507 patients treated between 1967 and 1986: end results and the determinants of depth.  J Burn Care Rehabil. 1996;  17 137-146
• 9 Cole J K, Engrav L H, Heimbach D M, Gibran N S, Costa B A, Nakamura D Y, Moore M L, Blayney C B, Hoover C L. Early excision and grafting of face and neck burns in patients over 20 years.  Plast Reconstr Surg. 2002;  109 1266-1273
• 10 Cope O, Langohr J L, Moore F D. et al. . Expeditious care of full-thickness burn wounds by surgical excision and grafting.  Ann Surg. 1947;  125 1-21
• 11 Cubison T C, Pape S A, Jeffery S L. Dermal preservation using the Versajet hydrosurgery system for debridement of paediatric burns.  Burns. 2006;  32 714-720
• 12 Deitch E A, Smith B J. The effect of blister fluid from thermally injured patients on normal lymphocyte transformation.  J Trauma. 1983;  23 106-110
• 13 Deitch E A. Opsonic activity of blister fluid from burn patients.  Infect Immun. 1983;  41 1184-1189
• 14 De Souza B A, Furniss D, Jawad M. The use of sandpaper as a precision tool for dermabrasion in burn surgery.  Plast Reconstr Surg. 2005;  116 350-351
• 15 Engrav L, Heimbach D M, Reus J L, Harner T J, Marvin J A. Early excision and grafting versus nonoperative treatment of burns of indeterminant depth: a randomized prospective study.  J Trauma. 1983;  23 1001-1004
• 16 Flanagan M, Graham J. Should burn blisters be left intact or debrided?.  J Wound Care. 2001;  10 41-45
• 17 Frist W, Ackroyd F, Burke J, Bondoc C. Long-term functional results of selective treatment of hand burns.  Am J Surg. 1985;  149 516-521
• 18 Garner W L, Zuccaro C, Marcelo C, Rodrigues J L, Smith D J. The effects of blister fluid on keratinocytes proliferation and differentiation.  J Burn Care Rehabil. 1993;  14 127-131
• 19 Granick M, Boykin J, Gamelli R, Schultz G, Tenenhaus M. Toward a common language: surgical wound bed preparation and debridement.  Wound Repair Regen. 2006;  14 (Suppl 1) S1-S10
• 20 Green H A, Burd E, Nishioka N S, Bruggemann U, Compton C C. Middermal wound healing. A comparison between dermatomal excision and pulsed carbon dioxide laser ablation.  Arch Dermatol. 1992;  128 639-645
• 21 Hansbrough J F, Peterson V M, Kortz E, Piacentine J. Postburn immunosuppression: monocyte dysfunction induced by burned tissue.  Surgery. 1983;  93 415-427
• 22 Hansbrough J F, Zapata-Sirvent R L, Peterson V M, Bender E, Claman H, Boswick J A. Characterization of the immunosuppressive effect of burned tissue in an animal model.  J Surg Res. 1984;  37 383-393
• 23 Heggers J P. Defining infection in chronic wounds: methodology.  J Wound Care. 1998;  7 452-456
• 24 Herndon D N, Barrow R E, Rutan R L, Rutan T C, Desai M H, Abston S. A comparison of conservative versus early excision. Therapies in severely burned patients.  Ann Surg. 1989;  209 547-552 552-553
• 25 Howes E L, Mandl J, Zafferto S, Ackermann W. The use of Clostridium histolyticum enzymes in the treatment of experimental third degree burns.  Surg Gyn Obstet. 1959;  109 177-188
• 26 Janzekovic Z. A new concept in the early excision and immediate grafting of burns.  J Trauma. 1970;  10 1103-1108
• 27 Kirn D S, Luce E A. Early excision and grafting versus conservative management of burns in the elderly.  Plast Reconstr Surg. 1998;  102 1013-1017
• 28 Klasen H J. A review on the nonoperative removal of necrotic tissue from burn wounds.  Burns. 2000;  26 207-222
• 29 Klein M B, Moore L M, Costa B, Engrav L H. Primer on the management of face burns at the University of Washington.  J Burn Care Rehabil. 2005;  26 2-6
• 30 Klein M B, Hunter S, Heimbach D M, Engrav L H, Honari S, Gallery E, Kiriluk D M, Gibran N S. The Versajet water dissector: a new tool for tangential excision.  J Burn Care Rehabil. 2005;  26 483-487
• 31 Kosaka K, Suzuki K, Hayakawa M, Sugiyama S, Ozawa T. Leukotoxin, a linoleate epoxide: its implication in the late death of patients with extensive burns.  Mol Cell Biochem. 1994;  139 141-148
• 32 Kremer B, Allgower M, Graf M, Schmidt K H, Schoelmerich J, Schoenenberger G A. The present status of research in burn toxins.  Intensive Care Med. 1981;  7 77-87
• 33 Levine N S, Peterson H D, Salisbury R E, Pruitt Jr B A. Laser, scalpel, electrosurgical, and tangential excisions of third degree burns. A preliminary report.  Plast Reconstr Surg. 1975;  56 286-296
• 34 Losee J E, Fox I, Hua L B, Cladis F P, Serletti J M. Transfusion-free pediatric burn surgery: techniques and strategies.  Ann Plast Surg. 2005;  54 165-171
• 35 Marazzi M, Stefani A, Chiaratti A, Ordanini M N, Falcone L, Rapisarda V. Effect of enzymatic debridement with collagenase on acute and chronic hard-to-heal wounds.  J Wound Care. 2006;  15 222-227
• 36 Ogura H, Tanaka H, Koh T, Hashiguchi N, Kuwagata Y, Hosotsubo H, Shimazu T, Sugimoto H. Priming, second-hit priming and apoptosis in leukocytes from trauma patients.  J Trauma. 1999;  46 774-781
• 37 Ono I, Gunji H, Zhang J Z, Maruyama K, Kaneko F. A study of cytokines in burn blister fluid related to wound healing.  Burns. 1995;  21 352-355
• 38 Palmieri T L, Greenhalgh D G. Topical treatment of pediatric patients with burns: a practical guide.  Am J Clin Dermatol. 2002;  3 529-534
• 39 Pennisi V R, Capozzi A, Friedman G. Travase, an effective enzyme for burn debridement.  Plast Reconstr Surg. 1973;  51 371-376
• 40 Pennisi V R, Capozzi A. Travase: observations and controlled study of effectiveness in burn debridement.  Burns. 1974 - 1975;  1 274-278
• 41 Pennisi V R, Abril F, Capozzi A. The combined efficacy of Travase and Silver sulfadiazine in the acute burn.  Burns. 1975 - 1976;  2 169-172
• 42 Pietsch J B, Netscher D T, Nagaraj H S, Groff D B. Early excision of major burns in children: effect on morbidity and mortality.  J Pediatr Surg. 1985;  20 754-757
• 43 Rennekampff H-O, Hansbrough J F, Tenenhaus M, Kiessig V, Yi E S. Effects of early and delayed wound excision on pulmonary leukosequestration and neutrophil respiratory burst activity in burned mice.  Surgery. 1995;  118 884-892
• 44 Rennekampff H-O, Schaller H E, Wisser D, Tenenhaus M. Debridement of burn wounds with a water jet surgical tool.  Burns. 2006;  32 64-69
• 45 Reynolds N, Cawrse N, Burge T, Kenealy J. Debridement of a mixed partial and full thickness burn with an Erbium : YAG laser.  Burns. 2003;  29 183-188
• 46 Robson M C, Heggers J P. Bacterial quantification of open wounds.  Mil Med. 1969;  134 19-24
• 47 Robson M C, Heggers J P. Delayed wound closure based on bacterial counts.  J Surg Oncol. 1970;  2 379-383
• 48 Rustogi R, Mill J, Fraser J F, Kimble R M. The use of Acticoat in neonatal burns.  Burns. 2005;  31 878-882
• 49 Sargent R L. Management of blisters in the partial-thickness burn: an integrative research review.  J Burn Care Res. 2006;  27 66-81
• 50 Sheridan R L, Lydon M M, Petras L M, Schomacker K T, Tompkins R G, Glatter R D, Parrish J A. Laser ablation of burns: initial clinical trial.  Surgery. 1999;  125 92-95
• 51 Silfen R, Amir A, Feinmesser M, Hauben D J. Subdermabrasion in the treatment of post-burn facial hypertrophic scars.  Aesthetic Plast Surg. 2002;  26 139-141
• 52 Singh G, Snelling C FT, Hogg G R, Waters W R. Debridement of the burn wound with sutilains ointment.  Burns. 1980 - 1981;  7 41-48
• 53 Sorensen B, Fisker N P, Steensen J P, Kalaja E. Acute excision or exposure treatment?.  Scand J Plast Reconstr Surg. 1984;  18 87-93
• 54 Soroff H S, Sasvary D H. Collagenase ointment and polymyxin B sulfate/bacitracin spray versus silver sulfadiazine cream in partial-thickness burns: a pilot study.  J Burn Care Rehabil. 1994;  15 13-17
• 55 Steadman P B, Pegg S P. A quantitative assessment of blood loss in burn wound excision and grafting.  Burns. 1992;  18 490-491
• 56 Steed D L, Donohoe D, Webster M W, Lindsley L. Effect of extensive debridement and treatment on the healing of diabetic foot ulcers. Diabetic Ulcer Study Group.  J Am Coll Surg. 1996;  183 61-64
• 57 Still J M, Law E J, Craft-Coffman B. An evaluation of excision with application of autografts or porcine xenografts within 24 hours of burn injury.  Ann Plast Surg. 1996;  36 176-179
• 58 Tenenhaus M, Rennekampff H O, Bhavsar D. Treatment of deep partial thickness and indeterminate depth facial burn wounds with water-jet debridement and a biosynthetic dressing.  Injury. 2007; 
• 59 Thompson P, Herndon D N, Abston S, Rutan T. Effect of early excision on patients with major thermal injury.  J Trauma. 1987;  27 205-207
• 60 Wilson Y, Goberdhan N, Dawson R A, Smith J, Freedlander E, MacNeil S. Investigation of the presence and role of calmodulin and other mitogens in human burn blister fluid.  J Burn Care Rehabil. 1994;  15 303-314
• 61 Xiao-Wu W, Herndon D N, Spies M, Sanford A P, Wolf S E. Effects of delayed wound excision and grafting in severely burned children.  Arch Surg. 2002;  137 1049-1054