724 Factors Influencing Healing Time After Enzymatic Debridement

Abstract

Abstract Introduction Enzymatic debridement (ED) as a noninvasive method is widely used and has been researched in several studies. The influence of key components of the trauma and overall treatment on healing time are often underrepresented. This paper describes the results from 56 wounds treated in a burn unit to evaluate factors influencing the healing time. Methods From all patients admitted to our unit from the year 2014 to 2016, 56 were treated with ED. Preclinical data and clinical data were compared in a retrospective review. Patients were divided into two groups with a separator of healing time of 30 days. Results ED was provided in 56 wounds in 52 patients on average to 7.0% ± 6.0 %, median 4.8% of patient’s body surface area. Comparing the group with a healing time of more than 30 days and less than 30 days. Statistically significant differences with a p< 0.05 were found in the rate of preclinical intubations, inhalation injuries, the application of fluids before admission, the type of dressing used and the BAUX index. Highly significant differences with a p< 0.01 were found in the ratio of pseudoeschars which had to be operated on and in the modified BAUX index (MBI). Mostly used dressings were a polylactic membrane (PLM) and silicone dressings. In the silicone group, MBI was significantly higher than in the polylactic group and healing time was significantly faster in the PLM group. Comparing groups with a higher than average MBI of 67.5 the PLM and the silicone group had a comparable MBI (p=0.337), but the PLM group had a five days shorter healing time of 43 days (p=0.2768). In a logistic regression formula over all PLM and Silicone patients (Days for healing after ED = 1.53 + 8.9 * dressing (PLM=1, silicone=2) + 0.35*MBI - 5.15483*incomplete debridement (Yes=1, No=0) + 7.96*pseudoeschar to be operated on (Yes=1, No=0) the influence of dressings could be demonstrated. No statistical differences (p >0.05) could be found in age, etiology of burn (fire scald, electric current injury or electrical arch with a p=0.4), location of accident out- or inside a building, cold water therapy applied or not, in TBSA, percentage of partial deep burns and full-thickness burns or the percentage of patients taken to ICU as inpatients and the timing of ED as well as the completeness of ED and in ABSI. Conclusions Healing time was dependent on parameters such as preclinical intubations, inhalation injuries, dressings used, and the severity calculated by MBI. Dressings are one of the few settings which can be changed proactively to achieve better outcomes. PLM over all clinical conditions have a shorter healing time (31 days) compared to silicon dressings (49 days) Applicability of Research to Practice Immediate.