Comparison of selective debridement methods efficiencies for treatment of the forearm and hand deep dermal burns

Abstract

Aim: Comparison of selective debridement methods efficiencies for treatment of the forearm and hand deep dermal burns. Method: We represent randomized, controlled, single-blind, parallel-group clinical trial designed to compare enzymatic, mechanical and autolytic debridement methods for treatment of the forearm and hand deep dermal burns. Patients were selected using clinical burn investigation and Laser Doppler imaging (LDI) and randomized into four groups. LDI burn wound healing prediction of no more than three weeks was the obligatory factor to access the study. For the first (control) group we used standard treatment - dressings with silver sulfadiazine cream. The second patients group got for the burn treatment hydrocolloid dressings which promote autolytic debridement. The third patients group got treatment combination - dressings with silver sulfadiazine cream and mechanical debridement with special single-use pad of monofilament polyester fibers. The fourth group was treated with enzymatic dressings. Study lasted three weeks for each patient till total burn wound epithelization happened; alternatively split thickness grafting was performed. Results / Discussion: The highest speed of burn wound epithelialization was observed in the second group of patients (hydrocolloid dressings) 17.3 ± 2,8 days. No bacterial contamination and infection symptoms were detected in all groups after 7 days treatment. During mechanical debridement procedure with the monofilament polyester fibers pad massive capillary bleeding and increased burn wound pain (VAS: 4.8 points) after redressing was detected. Conclusion: Hydrocolloid dressing seems to be an effective instrument for selective debridement and treatment of of the forearm and hand deep dermal burns with LDI healing prediction less than three weeks.