CME 23/04/2022 Summary
Systemic enzyme therapy with Trypsin, Bromelain and Rutoside Combination in Burns MODERATOR SPEAKER
Dr. Suhas Abhyankar MBBS, MCPS, MS - General Surgery, MCh - Plastic Surgery, DNB - Plastic Surgery
Dr. Arvind Vartak MBBS, MS – Gen Surgery, MS- Plastic Surgery
• Burns – A major public health problem worldwide • Main target in burns management – preventing complications, assisting physiological recovery • Targeting unchecked inflammation – key in faster recovery Case – High voltage electric flash injury → Thermal 3rd degree burns on dorsal aspect of left hand • Best modality - Conservative management with anti-inflammatory enzymes, and autograft after good granulation • Less effective modalities – i) Management with NSAIDs, and autograft after good granulation; ii) Tangential excision and cover with cadaveric graft followed by autograft Most common causes of failed or compromised skin graft • Poor vascularity • Hematoma or seroma, i.e., collections of blood or fluid • Infection at graft site • Mechanical shearing rd
Case – flame burns on dorsal aspects of right hand - 3 degree burns • Autograft after conservative management with NSAIDs → lot of swelling with impaired graft uptake • NSAIDs not effective in reducing edema; compromises graft uptake Risks with use of NSAIDs • Gastro-intestinal irritation • Renal disturbances (burns patients have hypovolemia) • Cardiovascular events • Potential hepatotoxicity • Marked negative impact on wound healing; may increase scar formation rd
Case - flame burns on right hand - 3 degree burns • Good recovery with anti-inflammatory enzymes; potentially due to: • Reduced edema; promoting healing • Local epidermal growth factor activation • Enhanced perfusion; better healing • Reduced edema & fibroblastic activity → better functional results in case of small hand joints