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Enzymatic debridement of burn wound with collagenase in children with partial-thickness burns
Coşkun Ozcan1, Orkan Ergün, Ahmet Celik
1Ege University Faculty of Medicine, Department of Pediatric Surgery, Pediatric Burns Unit, 35100 Bornova, Izmir, Turkey. cozcan@med.ege.edu.tr
Insights
Enzymatic debridement with collagenase clostridiopeptidase A (CCA) offers a shorter hospital stay and reduced need for surgery and transfusions in pediatric partial-thickness burns. CCA is a viable initial treatment for non-infected burn wounds in children.
Area of Science:
- Pediatric Burn Care
- Wound Debridement
- Enzymatic Therapy
Background:
- Surgical excision is a common method for burn eschar removal.
- Enzymatic debridement offers a less invasive alternative.
- Partial-thickness burns require effective and timely wound management.
Purpose of the Study:
- To compare enzymatic debridement using collagenase clostridiopeptidase A (CCA) with surgical excision in pediatric burn patients.
- To evaluate the efficacy of CCA in achieving a clean wound bed, need for further surgery, blood transfusions, and hospital stay.
- To determine if CCA is a suitable initial treatment for partial-thickness pediatric burns.
Main Methods:
- Retrospective comparison of 78 pediatric patients treated with CCA (groups D and DS) versus 41 patients treated with surgical excision (group S).
- Patients had partial-thickness burns assessed at admission.
- Outcomes measured included time to clean wound bed, number of excisions, need for blood transfusion, and hospital length of stay.
Main Results:
- No significant difference in time to achieve a clean wound bed between groups (mean 7.8 days for CCA vs. 7 days for surgery).
- Patients treated with CCA (group D) had significantly shorter hospital stays (12.5 days) and fewer required blood transfusions compared to surgical excision.
- A subset of CCA-treated patients (group DS) required subsequent surgery, but fewer overall excisions than the surgical group.
Conclusions:
- Collagenase clostridiopeptidase A (CCA) is effective for eschar removal in pediatric partial-thickness burns, leading to shorter hospitalizations.
- CCA reduces the need for blood transfusions and potentially decreases the overall number of surgical interventions.
- CCA should be considered a primary treatment option for non-infected partial-thickness pediatric burn wounds.
Abstract:
Seventy-eight pediatric burn patients treated by enzymatic debridement with collagenase clostridiopeptidase A (CCA), were compared to 41 patients those burn wounds were excised surgically. Patients whose burn wounds were initially assessed as partial-thickness at admission were enrolled in the study. Total removal of eschar was achieved in 49 of 78 (62.8%) patients by CCA only (group D). In 29 patients (37.2%), therapy with CCA was ceased because of the development of burn wound infection or a manifest need for grafting of the wound, therefore, these patients underwent tangential wound excision (group DS). The records of 41 patients, treated by early tangential excision, having similar burn wounds by extent and depth with groups D and DS were used as controls (group S). There was no significant difference between the time to achieve a clean wound bed in groups D, DS and S (mean 7.8, 8, and 7 days, respectively, P>0.05). In group D, none of the patients required blood transfusion, except one. Patients in group DS were found to have fewer excisions (mean 1.1) when compared to those in group S (mean 1.5, P<0.05). The shortest hospital stay was found in group D (12.5 days, P<0.01). In conclusion, the use of CCA, provided a short hospital stay, reduced the overall need for surgery and blood transfusions in patients with partial-thickness burns. Thus, CCA should be considered as an initial treatment of choice for removal of eschar in children, having a partial-thickness burn wound without infection.
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