Publication details
Role chemické nekrektomie v léčbě hlubokých popálenin u dětí
| Title in English | The role of a chemical necrectomy in the treatment of deep burns in children |
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| Authors | |
| Year of publication | 2010 |
| Type | Article in Periodical |
| Magazine / Source | Hojení ran |
| MU Faculty or unit | |
| Citation | |
| Field | Traumatology and orthopaedic surgery |
| Keywords | burns chemical necrectomy benzoic acid |
| Description | Background The burns belong to frequent in the child age. Deep burns may potentially complicate the growth and development of the burnt parts of the body, subsequently also their function, and may have serious negative impact on the psychological status of the patient. The surgical treatment of deep burns is based on a removal of the necrotic skin (necrectomy) and a closure of an emerged defect most frequently by an autologous skin graft. Worldwide, the necrectomy is most frequently performed by a tangential excision. However, the Clinic of Burns and Reconstructive Surgery in Brno has gained an excellent long term experience with chemical necrectomy performed by a 40% solution of benzoic acid. In this paper we present outcomes of the chemical necrectomy, ad an alternative to established methods for removal of devitalized tissues in the treatment of deep burns in pediatric patients. Material and methods The project was performed as a retrospective clinical trial. Children at the age 0-14 years hospitalized in out clinic between 2006 and 2009 were included. The main inclusion criteria were a presence of a deep burn injury and a need of necrectomy. In all children, predefined epidemiological indicators, such as age, the extent of burnt area, duration of hospitalization, success of the chemical necrectomy, time from the injury to the autologous transplantation, etc., were monitored and subsequently evaluated. Results Between 01 Jan 2006 and 31 Dec 2009, a total of 633 children were hospitalized due to a thermal injury. In 116 children (18.3%) the necrectomy had to be performed. The average age of the patients in the cohort, thus those undergoing necrectomy, was 4.7 years (11 months 19 years), the average area of the burnt was 12.8% TBSA (0,5 75%). The average duration of hospitalization of patients included in the cohor was 20.9 days (12 132 days). The average time from the injury to the chemical necrectomy and the closure of the defect by a dermo epidermal (D E) graft was 9.2 (8-13 days). Only in 8 children the surgical necrectomy had to be performed. In 108 children (93.1 %) we chose the chemical necrectomy. The success rate of the chemical necrectomy (thus removal of the necrotic tissues) was 94.4 % in our cohort. Discussion The number of children hospitalized due to burn injury has been increasing year by year. Luckily, the number of critical burn injuries and therefore the need of necrectomy have been decreasing. In the Clinic of Burns and Reconstructive Surgery, the chemical necrectomy is highly favored over the tangential excision. In the extensive burn injuries both methods are successfully combined, which enables to perform the necrectomy of the affected areas in a shorter time and to reduce the extent of blood loss. There has been a general trend for an early excision of deep necrotic tissues in the burn injury medicine over the last decades. Some centers perform the necrectomy directly at the admission of a patient to the department. The truth is that in our departement the necrectomy is performed later than is usual, on the other hand, in majority of pediatric patients the defect is closed definitely immediately after the necrectomy. In contrast with statements of the very early excision supporters, we have observed neither increased incidence of infectious complications nor increased incidence of the hypertrophic healing of the burnt areas following the autologous transplantation with D-E grafts. The efficacy of the chemical necrectomy by benzoid acid in children is very good, nevertheless, sporadic cases, in which the method fails even in pediatric patients, can be found. The cause of this phenomenon remains unknown. In our opinion, it is associated with the likely mode of action of the benzoic acid itself in the separation of necrosis. |