Escharotomy using an enzymatic debridement agent for treating experimental burn-induced compartment syndrome in an animal model

Yuval Krieger, Lior Rosenberg, Oren Lapid, Ronen Glesinger, Alex Bogdanov-Berezovsky, Eldad Silberstein, Amiram Sagi, Keith Judkins

    Research output: Contribution to journalArticlepeer-review

    52 Scopus citations

    Abstract

    Background: In patients with deep circumferential burns, adequate resolution of burn-induced compartment syndrome (BICS) is achieved by surgical escharotomy. Surgical escharotomy is traumatic, may cause considerable blood loss, does nothing toward debridement of the burn wound, and entails possible morbidity and complications. Debridase is a Bromelain derived enzymatic preparation capable of lysing the burn eschar within 4 hours, obviating the need for surgical debridement. It has an affinity to burned necrotic tissue and does not damage healthy skin. In our clinical assessment of the Debridase efficacy, we found in several cases of deep burns of the limbs that the measured IC pressure subsided after 2-4 hours of Debridase® application and none of the enzymatic escharotomy treated patients suffering from circumferential burns developed BICS. To confirm these observations we conducted this controlled study. Aim: to assess the efficacy of Debridase for treating BICS in an animal model. Materials and Methods: A model for BICS was developed by making circumferential burns to pig legs and monitoring the anterior compartment the legs. BICS was induced in the legs of 5 pigs, 20 legs. 10 legs were treated with Debridase and 10 served as nontreated controls, treated by surgical escharotomy at the conclusion of the experiment. Results: Debridase reduced BICS within 30 minutes from application. Debridase was as effective as a standard surgical escharotomy. Conclusion: Escharectomy using an effective enzymatic debriding agent is potentially an adequate, simple, fast and effective procedure to treat BICS, it has the added benefit of burn debridement without surgical escharotomy.

    Original languageEnglish
    Pages (from-to)1259-1264
    Number of pages6
    JournalJournal of Trauma and Acute Care Surgery
    Volume58
    Issue number6
    DOIs
    StatePublished - 1 Jun 2005

    Keywords

    • Bromelain
    • Burn compartment syndrome
    • Debrase
    • Debridase
    • Debridement
    • Enzyme
    • Escharotomy
    • Pig burn model

    ASJC Scopus subject areas

    • Surgery
    • Critical Care and Intensive Care Medicine

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