Benjamin Ziegler

Suprathel(®) for severe burns in the elderly: Case report and review of the literature.

Large burns in aged patients are common and treatment often reveals challenging. Cardiovascular complications significantly contribute to the unfavorable prognosis in this group of high-risk patients. Pain medication and sedation can negatively influence cardiovascular stability. Suprathel(®) is well-known for its almost pain free application and reduction of dressing change intervals, and thus lowers the demand for potentially harmful analgesics and sedatives. We present the case of an 81-year-old patient with 51% of total burned body surface area (ABSI=12), who was completely treated with Suprathel(®). Despite a predicted mortality of more than 80%, the patient survived and was discharged home without significant handicaps 69 days after burn. We hypothesize that Suprathel(®) beneficially contributed to the favorable clinical course of this critical patient as less frequent wound-dressing changes did not induce additional pain or sedative medication and thus improved cardiovascular stability.

In view of standardization: Comparison and analysis of initial management of severely burned patients in Germany, Austria and Switzerland

INTRODUCTION Initial treatment of severely injured patients in German speaking trauma centers follows precise sequences. Several guidelines and training courses ensure a constant quality in providing evidence-based treatment for these patients. Similar standards, algorithms and guidelines for the treatment of severely burned patients are lacking. This raises the question about the current standard of care for burn victims in German speaking burn centers. In order to achieve standardization, as a first step this study surveys principles of burn room organization and management in these burn centers. MATERIAL AND METHODS A questionnaire including 40 questions regarding burn room organization, personnel structure and qualification, infrastructural conditions and quality management was developed and sent to 21 level one burn centers in Germany, Austria and Switzerland. RESULTS The rate of returned questionnaires was 81%. The analysis revealed varying personnel and infrastructural conditions in participating burn centers. Indications for admission to the burn room and admission procedures itself are different throughout surveyed hospitals. Individual standard operating procedure (SOP) for burn trauma admissions was available in most burn centers and nearly all participants register their burn trauma cases using an in-house burn register. CONCLUSION The survey suggests a lack of standardization in personnel structure, infrastructure and treatment approach for the initial clinical care of severely burned patients in burn centers across the German speaking countries. Further evaluation of existing protocols and international standards in burn care is inevitable to develop standardized guidelines for burn care and to improve quality of care.

In view of standardization Part 2: Management of challenges in the initial treatment of burn patients in Burn Centers in Germany, Austria and Switzerland

INTRODUCTION Initial therapy of severe burns in specialized burn trauma centers is a challenging task faced by the treating multi-professional and interdisciplinary team. A lack of consistent operating procedures and varying structural conditions was recently demonstrated in preliminary data of our group. These results raised the question on how specific treatment measures in acute burn care are met in the absence of standardized guidelines. MATERIAL AND METHODS A specific questionnaire containing 57 multiple-choice questions was sent to all 22 major burn centers in Germany, Austria and Switzerland. The survey included standards of airway management and ventilation, fluid management and circulation, body temperature monitoring and management, topical burn wound treatment and a microbiological surveillance. Additionally, the distribution of standardized course systems was covered. RESULTS 17 out of 22 questionnaires (77%) were returned completed. Regarding volume resuscitation, results showed a similar approach in estimating initial fluid while discrepancies persisted in the use of colloidal fluid and human albumin. Elective tracheostomy and the need for bronchoscopy with suspected inhalation injury were the most controversial issues revealed by the survey. Topical treatment of burned body surface also followed different principles regarding the use of synthetic epidermal skin substitutes or enzymatic wound debridement. Less discrepancy was found in basic diagnostic measures, body temperature management, estimation of the extent of burns and microbiological surveillance. CONCLUSION While many burn-related issues are clearly not questionable and managed in a similar way in most participating facilities, we were able to show that the most contentious issues in burn trauma management involve initial volume resuscitation, management of inhalation trauma and topical burn wound treatment. Further research is required to address these topics and evaluate a potential superiority of a regime in order to increase the level of evidence.

State of the art in enzymatic debridement

Surgical treatment of deep partial thickness to full thickness burn wounds by knife has been the undisputed standard of care and was one key point in surgical burn medicine for decades. Recently, it gets more and more challenged by Bromelain-based enzymatic burn wound debridement (ED) as technique for non-surgical, selective eschar removal. Although the literature on ED is increasing constantly it cannot comprise the rapid progress that is made in clinical application of ED. To outline the current state of art in ED, recent literature as well as clinical experience is summarized and the main steps in clinical application including indications, wound preparation, application of the enzyme, wound bed assessment and further treatment after ED are discussed. Initial indications and limitations in application of ED could be gradually extended to increase versatility of ED as tool in burn surgery. Several randomized controlled trials compared ED to standard of care (SOC). They could show significant shorter time to complete burn wound debridement and wound closure, reduced need for surgery, reduced blood loss, reduced area of burns that needed surgical excision and need for autograft as well as an improved scar quality. Further research is necessary to justify an extensive use of ED as tool for burn eschar removal. Especially a robust comparison to surgical burn wound excision by knife as SOC is required to facilitate evidence-based burn surgery.

Efficacy of a Gel Containing Polihexanide and Betaine in Deep Partial and Full Thickness Burns Requiring Split-thickness Skin Grafts: A Noncomparative Clinical Study

Despite overall advances in burn therapy, wound infection remains one of the leading causes of morbidity and mortality in patients with severe burn injuries. This prospective, multicenter, noncomparative clinical trial was conducted to assess the efficacy and safety of Prontosan® Wound Gel X (PWX), a gel containing polihexanide and betaine, for moistening and cleansing in deep tissue burn wounds requiring split-thickness skin grafting. Patients with deep partial or full thickness burn wounds requiring split-thickness skin grafting were treated with the gel to evaluate its tolerability and safety as well as graft take and the healing of the skin graft. Target wounds were assessed clinically and by using a photo-planimetric analyzing software for re-epithelialization. From 04/2012 to 05/2015, burn patients from three burn centers in Germany were screened for the study, of which 51 patients met the inclusion criteria. Predominantly deep partial thickness burn wounds were found (88.2 %). Except for one graft failure, all patients reached complete re-epithelialization after one (n = 14), two (n = 31), or three (n = 5) administrations of the gel. The median time to complete graft take was 7 days and was below the average healing time reported in comparable studies. No wound infection or erythema occurred. This is the first study to document the outcomes of deep partial and full thickness burns treated with PWX for moistening and cleansing. The gel was shown to be efficacious, safe, and well tolerated for use in burn wounds requiring split-thickness skin grafts.

Aktuelle Standards in der VerbrennungsmedizinCurrent standards in treatment of burns

ZusammenfassungThermische Traumata können zu lebensbedrohlichen Schädigungen und zu bleibenden funktionellen und ästhetischen Verletzungsfolgen führen. Eine optimale Therapie verbessert die Prognose für den Verletzten und kann signifikante Langzeitschäden abwenden. Die optimale Prognose vor Augen, beginnt multidisziplinäre Zusammenarbeit bereits in der präklinischen Versorgung, während der Akuttherapie im Schwerbrandverletztenzentrum sowie in der sich anschließenden Rehabilitationsbehandlung und rekonstruktiven Phase und sollte aktuellen Standards der Verbrennungsmedizin folgen. Stetige Weiterentwicklungen dieser Standards der letzten Jahre betreffen dabei jede Phase der Verbrennungsbehandlung: Während in der präklinischen Behandlung das vornehmliche Augenmerk auf Temperaturerhalt und Volumensubstitution gelegt wird, ist die chirurgische Behandlung durch Innovationen wie permanente und temporäre Dermisersatzmaterialien und enzymatische Wunddébridements geprägt. In der Phase der Rehabilitation schwerbrandverletzter Patienten ist der Stellenwert einer multiprofessionell organisierten stationären Behandlung inzwischen unbestritten und soll in engem Kontakt mit rekonstruktiv-chirurgisch tätigen Teams erfolgen, um rechtzeitig funktionelle Limitation zu beseitigen. Wenn die Akutphase einer Verbrennung überwunden ist, bleiben deren Folgen oft ein Leben lang behandlungsbedürftig. Spezialisierte Sprechstunden sind notwendig, um in dieser Phase bedarfsgerechte und prognoseverbessernde konservative und stellenweise chirurgische Therapieverfahren rechtzeitig anbieten zu können.AbstractThermal trauma can lead to life-threatening damage and permanent functional and aesthetic sequelae of injuries. The optimal therapy improves the prognosis for injured persons and can prevent significant long-term damage. With the optimal prognosis in mind, the multidisciplinary cooperation begins during the preclinical care, during the acute treatment in a center for severe burn injuries and in the subsequent rehabilitation therapy and reconstruction phase. This should be carried out according to the current standards in the treatment of burns. Continuous further development of these standards in recent years have involved all phases of burn treatment: whereas in the preclinical treatment the main emphasis is on maintaining temperature and volume substitution, the surgical treatment is characterized by innovations, such as permanent and temporary dermal replacement materials and enzymatic wound debridement. In the rehabilitation phase of severely burned patients, the importance of a multiprofessionally organized inpatient treatment is nowadays undisputed and should be carried out in close cooperation with reconstructive surgery teams, for a timely resolution of functional limitations. When the acute phase of burn injuries has been overcome the sequelae often remain in need of treatment for life. Specialized medical consultation is necessary during this phase for timely provision of adequate conservative and sometimes surgical therapy procedures to improve the prognosis.

Aktuelle Standards in der Verbrennungsmedizin@@@Current standards in treatment of burns: Akuttherapie, Rehabilitation und Rekonstruktion idealerweise aus einer Hand@@@Acute therapy, rehabilitation and reconstruction ideally under one roof

ZusammenfassungThermische Traumata können zu lebensbedrohlichen Schädigungen und zu bleibenden funktionellen und ästhetischen Verletzungsfolgen führen. Eine optimale Therapie verbessert die Prognose für den Verletzten und kann signifikante Langzeitschäden abwenden. Die optimale Prognose vor Augen, beginnt multidisziplinäre Zusammenarbeit bereits in der präklinischen Versorgung, während der Akuttherapie im Schwerbrandverletztenzentrum sowie in der sich anschließenden Rehabilitationsbehandlung und rekonstruktiven Phase und sollte aktuellen Standards der Verbrennungsmedizin folgen. Stetige Weiterentwicklungen dieser Standards der letzten Jahre betreffen dabei jede Phase der Verbrennungsbehandlung: Während in der präklinischen Behandlung das vornehmliche Augenmerk auf Temperaturerhalt und Volumensubstitution gelegt wird, ist die chirurgische Behandlung durch Innovationen wie permanente und temporäre Dermisersatzmaterialien und enzymatische Wunddébridements geprägt. In der Phase der Rehabilitation schwerbrandverletzter Patienten ist der Stellenwert einer multiprofessionell organisierten stationären Behandlung inzwischen unbestritten und soll in engem Kontakt mit rekonstruktiv-chirurgisch tätigen Teams erfolgen, um rechtzeitig funktionelle Limitation zu beseitigen. Wenn die Akutphase einer Verbrennung überwunden ist, bleiben deren Folgen oft ein Leben lang behandlungsbedürftig. Spezialisierte Sprechstunden sind notwendig, um in dieser Phase bedarfsgerechte und prognoseverbessernde konservative und stellenweise chirurgische Therapieverfahren rechtzeitig anbieten zu können.AbstractThermal trauma can lead to life-threatening damage and permanent functional and aesthetic sequelae of injuries. The optimal therapy improves the prognosis for injured persons and can prevent significant long-term damage. With the optimal prognosis in mind, the multidisciplinary cooperation begins during the preclinical care, during the acute treatment in a center for severe burn injuries and in the subsequent rehabilitation therapy and reconstruction phase. This should be carried out according to the current standards in the treatment of burns. Continuous further development of these standards in recent years have involved all phases of burn treatment: whereas in the preclinical treatment the main emphasis is on maintaining temperature and volume substitution, the surgical treatment is characterized by innovations, such as permanent and temporary dermal replacement materials and enzymatic wound debridement. In the rehabilitation phase of severely burned patients, the importance of a multiprofessionally organized inpatient treatment is nowadays undisputed and should be carried out in close cooperation with reconstructive surgery teams, for a timely resolution of functional limitations. When the acute phase of burn injuries has been overcome the sequelae often remain in need of treatment for life. Specialized medical consultation is necessary during this phase for timely provision of adequate conservative and sometimes surgical therapy procedures to improve the prognosis.

Aktuelle Standards in der Verbrennungsmedizin

ZusammenfassungThermische Traumata können zu lebensbedrohlichen Schädigungen und zu bleibenden funktionellen und ästhetischen Verletzungsfolgen führen. Eine optimale Therapie verbessert die Prognose für den Verletzten und kann signifikante Langzeitschäden abwenden. Die optimale Prognose vor Augen, beginnt multidisziplinäre Zusammenarbeit bereits in der präklinischen Versorgung, während der Akuttherapie im Schwerbrandverletztenzentrum sowie in der sich anschließenden Rehabilitationsbehandlung und rekonstruktiven Phase und sollte aktuellen Standards der Verbrennungsmedizin folgen. Stetige Weiterentwicklungen dieser Standards der letzten Jahre betreffen dabei jede Phase der Verbrennungsbehandlung: Während in der präklinischen Behandlung das vornehmliche Augenmerk auf Temperaturerhalt und Volumensubstitution gelegt wird, ist die chirurgische Behandlung durch Innovationen wie permanente und temporäre Dermisersatzmaterialien und enzymatische Wunddébridements geprägt. In der Phase der Rehabilitation schwerbrandverletzter Patienten ist der Stellenwert einer multiprofessionell organisierten stationären Behandlung inzwischen unbestritten und soll in engem Kontakt mit rekonstruktiv-chirurgisch tätigen Teams erfolgen, um rechtzeitig funktionelle Limitation zu beseitigen. Wenn die Akutphase einer Verbrennung überwunden ist, bleiben deren Folgen oft ein Leben lang behandlungsbedürftig. Spezialisierte Sprechstunden sind notwendig, um in dieser Phase bedarfsgerechte und prognoseverbessernde konservative und stellenweise chirurgische Therapieverfahren rechtzeitig anbieten zu können.AbstractThermal trauma can lead to life-threatening damage and permanent functional and aesthetic sequelae of injuries. The optimal therapy improves the prognosis for injured persons and can prevent significant long-term damage. With the optimal prognosis in mind, the multidisciplinary cooperation begins during the preclinical care, during the acute treatment in a center for severe burn injuries and in the subsequent rehabilitation therapy and reconstruction phase. This should be carried out according to the current standards in the treatment of burns. Continuous further development of these standards in recent years have involved all phases of burn treatment: whereas in the preclinical treatment the main emphasis is on maintaining temperature and volume substitution, the surgical treatment is characterized by innovations, such as permanent and temporary dermal replacement materials and enzymatic wound debridement. In the rehabilitation phase of severely burned patients, the importance of a multiprofessionally organized inpatient treatment is nowadays undisputed and should be carried out in close cooperation with reconstructive surgery teams, for a timely resolution of functional limitations. When the acute phase of burn injuries has been overcome the sequelae often remain in need of treatment for life. Specialized medical consultation is necessary during this phase for timely provision of adequate conservative and sometimes surgical therapy procedures to improve the prognosis.