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Treatment of Genital Burn Injuries: Traditional Procedures and New Techniques
Alexandra Schulz1, Benedikt Ribitsch, Paul Christian Fuchs
1In the Department of Plastic Surgery, Hand Surgery, and Burn Center, University of Witten/Herdecke, Cologne-Merheim Medical Center, Cologne, Germany, Alexandra Schulz, MD, is a Senior Resident; Benedikt Ribitsch, MD, is a Resident; Paul Christian Fuchs, PhD, is Professor and Director; Alexandra Lipensky, MD, is a Resident; and Jennifer Lynn Schiefer, MD, is a Senior Resident. Acknowledgments: The NexoBrid product for enzymatic debridement has been approved for use in Germany and is currently an investigational product in a phase III controlled FDA trial in the United States. Dr Schulz has disclosed that she is a consultant for MediWound Ltd, although the current study was not funded by the product manufacturer. The authors have disclosed no other financial relationships related to this article. Submitted February 19, 2017; accepted in revised form August 3, 2017.
Objective:
Because genital burns are rare, only limited information on treatment guidelines is available in the literature. Vital tissue should be preserved to promote spontaneous healing because reconstruction does not always lead to satisfying results. The aim of this report is to present a general overview of current, prevailing treatment for genital burns and compare this to study authors' experiences. In addition, the article describes an entirely new approach of tissue-preserving bromelain-based enzymatic debridement of genital burn wounds.
Methods:
This single-center study includes all patients who were treated for severe genital and perineal burn wounds at a burn intensive care unit between December 1995 and December 2016. A review of literature was performed in PubMed covering the years 1990 to 2016.
Results:
A total of 149 patients were admitted with severe burns or scalding of the genitals or the perineum. As in the majority of cases reported in the current literature, most of these patients were treated conservatively. When there was demarcation of necrotic tissue, tangential excision and skin grafting were performed, and since 2015, 3 patients admitted to this facility have been treated with bromelain-based debridement followed by spontaneous healing. Certain small-scale studies in the literature describe a disproportionate number of surgical interventions.
Conclusions:
Based on this evidence, study authors support a conservative view of genital burn treatment. Enzymatic debridement allows earlier and more selective debridement, which can improve the aesthetic outcome.
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