Efficacy of laser debridement with autologous split-thickness skin grafting in promoting improved healing of deep cutaneous sulfur mustard burns

The consequences of receiving a cutaneous sulfur mustard (SM) burn are prolonged wound healing and secondary infection. This study was undertaken to find a treatment that promotes quick healing with few complications and minimal disfigurement. Multiple deep SM burns (4 cm diameter) were generated on the ventrum of weanling pigs and treated at 48 h. Four treatments were compared: (1) full-thickness CO₂ laser debridement followed by skin grafting; (2) full-thickness sharp surgical tangential excision followed by skin grafting, the “Gold Standard” used in deep thermal burns management; (3) partial-thickness laser ablation with no grafting; and (4) partial-thickness sharp excision with no grafting. A computer controlled, raster scanned, high-powered continuous wave (cw) CO₂ laser was utilized. Ulceration, wound geometry, and wound contraction were evaluated during a 36-day healing period. Histopathological evaluations were conducted at the end of the healing period. Engraftment rates were similar between both methods of debridement. Laser debridement followed by skin grafting was as efficacious in improving the wound healing of deep SM burns as the “Gold Standard.” Full-thickness laser debridement of these small total body surface area (TBSA) burns was time efficient and provided adequate beds for split-thickness skin grafting. Laser debridement offered additional benefits that included hemostatic control during surgery and minimal debridement of normal perilesional skin. Mid-dermal debridement by sharp excision or laser ablation without grafting produced less desirable results but was better than no treatment.     

Tranexamic acid reduced blood transfusions in acute burn surgery: A retrospective case-controlled trial

ObjectiveEarly excision and grafting of burn wounds are key for reducing prevalence of infection and sepsis. However, it is associated with massive blood loss and patients frequently require large numbers of blood transfusions. This study aimed to evaluate the effect of tranexamic acid (TXA) on blood transfusion requirements in acute burn surgery.MethodsPatients admitted to the burn intensive care unit between January 2018 and May 2021 and received TXA before first surgery for wound excision and grafting were matched in a 1:2 ratio to patients that did not receive TXA (confounders age,sex,total body surface area (TBSA) burned). Primary endpoint of the analysis was the total number of transfused units of red blood cells (RBC) intra- and postoperatively up to 48 h. Fresh frozen plasma (FFP) and platelets were evaluated. Endpoints were compared between groups using van Elteren tests adjusting for strata variable age, gender, TBSA.ResultsTwenty-six TXA patients were matched with 52 control patients resulting in similar distributions of gender (77.9%(TXA)vs. 82.7%(control) males, p=0.542), age (51.7±21.3vs.48.3 ±17.4years,p = 0.459) and %TBSA burned (33.5%(IQR34)vs. 38.5% (IQR 30.5),p = 1.000). TXA group received significantly less RBC units intraoperatively (2.5(IQR 2.0)vs.4.0 units (IQR4.0), p = 0.038) and in total (4.0(IQR3.0)vs.6.0(IQR4.0),p = 0.017). TXA patients also received less blood products in general (RBC, FFP, platelets) in each period and in total. We found no significant difference in length of stay (24.0(IQR26.0)vs.33.0 days (IQR 0.5),p = 0.367) or mortality (15.4%vs.21.2%, p = 0.542).DiscussionThis study shows that necessity for blood transfusions in acute burn surgery may be reduced significantly by administration of TXA perioperatively. Randomized-controlled trials are needed to prove these findings.     

Effect of autologous fat transfer in acute burn wound management: A randomized controlled study

ObjectiveThe use of fat grafting is being widely used for different indications one of which is wound healing. In this study we compare the use of autologous fat grafting (AFG) as a novel indication in acute burn wounds healing and burn scarring to the conventional methods of burn wound management both clinically and histologically. Several small observational studies demonstrated the effect of the AFG in healing of chronic wounds, different vascular ulcers or effect on scars yet no randomized controlled trial is available to compare its role with conventional methods.MethodsThe study was a prospective, open-label single center, randomized control clinical trial included 100 patients with superficial and deep dermal burns from March 2019 to March 2020 randomized to AFG protocol consisted of a single injection of autologous fat grafting then dressed with nano fat (Group A) or conventional methods of serial dressings with 1% silver sulphadiazine or other topical agents (Group B). Inclusion criteria included newly admitted burn patients with affected total body surface area (TBSA) (10%?25%) while exclusion criteria included burns patients with affected TBSA of< 10% or> 25%, or loss of subcutaneous fat, fascia, muscles and bones, inhalational burn, and burns in genitalia, perineum and peri-anal areas and co-morbidity(ies) that might affect wound healing or eligibility for anaesthesia and surgery. Also, results were confirmed by histological analysis for samples from both groups by light microscopic examination, and the nano-fat was subjected to flow cytometric analysis of the cluster of differentiation (CD) markers of mesenchymal stem cells markers CD 90, CD44, CD45, CD 73, and CD 34. (ClinicalTrials.gov Identifier: NCT03791710)ResultsWe found a significant reduction in total hospital stay days (p = <0.001), less further skin grafting (p = 0.003), less contracture formation (p = <0.002) while scar texture improved (p = <0.001) in group A compared to group B. Flow cytometric analysis documented that the nano-fat was positive to CD 90, 73, 44, 45 and 34.ConclusionIn a comparison between AFG protocol to the conventional methods in the treatment of acute burn wounds, AFG protocol was associated with significant clinical improvement in the form of lower hospital stay time, lower incidence of scaring or contracture and lower skin grafting use which was confirmed by serial photographic and histological assessment.     

影响烧伤病人疗程的相关因素分析

目的 探讨如何减少烧伤病人治愈时间，缩短住院日，降低病人的治疗费用。方法 通过应用主成分分析的统计方法对我科７９１例病人进行回顾，度图找与病人治愈时间密切相关的因素。结果 烧面积的大小及深度、吸入性听凭、脓毒症、休克、内脏并发症、复合伤或合并伤和切痂面积、切痂时间、休克期切痂与否、抗生素应有理影响烧伤病人治愈时间和住院日的主要因素，进一步分析表明，休克期切痂病人内脏并发症及脓症的发生率低，治愈时间     

影响烧伤病人疗程的相关因素分析

目的探讨如何减少烧伤病人治愈时间,缩短住院日,降低病人的治疗费用。方法通过应用主成分分析的统计方法对我科791例病人进行回顾,试图找出与病人治愈时间密切相关的因素。结果烧伤面积的大小及深度、吸入性损伤、脓毒症、休克、内脏并发症、复合伤或合并伤和切痂面积、切痂时间、休克期切痂与否、抗生素应用时间等均是影响烧伤病人治愈时间和住院日的主要因素,进一步分析表明,休克期切痂病人内脏并发症及脓毒症的发生率低,治愈时间短,尤其是超过30%烧伤面积者,休克期切痂组病人治愈时间明显少于非休克期切痂组病人。结论积极防治休克、脓毒症及内脏并发症的发生发展,合理应用抗生素等,而更重要的是大面积深度烧伤创面早期切削痂植皮等均是缩短病人治愈时间的有效手段。     

异种(猪)脱细胞真皮基质一次性包扎治疗深Ⅱ度烧伤

目的探讨应用异种(猪)脱细胞真皮基质一次性包扎治疗深Ⅱ度烧伤创面的临床应用效果。方法1997年1月—2004年1月,应用异种(猪)脱细胞真皮基质一次包扎治疗50%~95%总体表面积(TBSA)、深Ⅱ度烧伤的患者67例[异种(猪)脱细胞真皮基质治疗组];同期保痂治疗的50%~95%TBSA、深Ⅱ度的患者10例(保痂治疗组),观察创面愈合时间和愈合质量及其并发症发生情况。治愈患者经过3个月~2年的随诊,观察瘢痕增生情况。结果异种(猪)脱细胞真皮基质治疗组深Ⅱ度创面中途基本不需换药,创面愈合时间缩短,平均(12.2±2.6)d,而保痂治疗组愈合时间为(27.4±3.5)d,差异具有统计学意义(P<0.05);同时,异种(猪)脱细胞真皮基质治疗组瘢痕增生情况较保痂治疗组明显减轻或者无瘢痕增生。结论一次性覆盖异种(猪)脱细胞真皮基质可有效地治疗深Ⅱ度烧伤创面,能加快创面愈合,减轻瘢痕增生,从而降低烧伤感染和炎症反应综合征的发生。     

烧伤后期特大未愈创面伴脓毒症患者的救治

This article analyzed the medical records of a patient with 90％ TBSA unhealed wound accompanied with wound sepsis 50 days post burn (PBD) and to discuss the ideal strategies of treatment for such patients in such condition.This was a 24-year-old male patient suffering from flame burn with 95％ TBSA wound and severe inhalation injury.Meek skin grafting with autologous scalp was performed once to the thoracic and abdominal regions; intermingled skin grafting of autologous scalp microskin and large sheet of allograft was performed twice to the limbs within PBD 31.The patient was transferred to our hospital on PBD 50 with 90％ TBSA wound unhealed,leaving a vast amount of necrotic tissue and allografts.Furthermore,he was complicated by sepsis,pulmonary infection,and gastric ulcer.Debridement and allogenic skin grafting were performed on the first day after hospitalization.When the condition of wounds was improved,transplantation of a large sheet of allogenic skin with inlaid small pieces of autologous skin,intermingled skin grafting of autologous and allogenic skin,and small pieces of autologous skin grafting were performed.Because of the shortage of donor area,the exposed wounds were temporarily covered with allogeneic skin.Epidermal growth factor was used to promote the healing of autologous skin donor site and deep partial-thickness bum wound.Autologous skin grafting was performed whenever source of healthy skin was available.Systemic use of effective antibiotics,nutritional support and therapy,and other comprehensive measures also contributed to the success of treatment of this patient suffering from wound sepsis.The patient was cured and discharged on PBD 145.     

空气流动床在我国西部高原地区大面积烧伤治疗中的应用观察

目的:观察在我国西部高原地区使用空气流动床治疗大面积烧伤的临床效果.方法:我院于2013年5月引进使用空气流动床,以此时间为分组标准,2010年4月30日-2013年4月30日收治的使用烧伤翻身床治疗的35例患者为翻身床组,创面予切削痂手术及植皮处理.2013年5月31日-2016年5月31日收治的使用空气流动床治疗的42例患者为空气流动床组,创面行保痂治疗及植皮处理.全部患者的烧伤面积＞47％TBSA,Ⅲ度烧伤面积＞30％TBSA.两组患者均行补液抗休克、抗感染、远红外烧伤治疗仪照射等治疗.观察两组患者创面干痂时间、创面感染情况、创面愈合时间、手术例数、休克期补液量、血制品用量、血钠值、住院时间及住院费用的差异.结果:空气流动床组创面干痂时间、创面愈合时间、住院时间均较翻身床组明显缩短(P＜0.01),手术例数、血制品用量、住院费用均明显减少(P＜0.01),创面感染率也明显下降(P＜0.05),休克期补液量则增加(P＜0.01),血钠值明显增加(P＜0.05).结论:空气流动床在大面积烧伤治疗中具有保护创面、减少创面感染和加速创面愈合的作用;但是会引起液体丢失增多、高渗性脱水,因此应当适当增加补液量.空气流动床总体上能减少手术次数、降低血制品消耗、缩短住院时间,尤其明显节省治疗费用,值得推广.     

Stromal vascular fraction improves deep partial thickness burn wound healing

ObjectiveThe practice of early burn wound excision and wound closure by immediate autologous skin or skin substitutes is the preferred treatment in extensive deep partial and full-thickness burns. To date there is no proven definite medical treatment to decrease burn wound size and accelerate burn wound healing in modern clinical practice. Stromal vascular fraction is an autologous mixture that has multiple proven beneficial effects on different kinds of wounds. In our study, we investigated the effects of stromal vascular fraction on deep partial-thickness burn wound healing.MethodsIn this study, 20 Wistar albino rats were used. Inguinal adipose tissue of the rats was surgically removed and stromal vascular fraction was isolated. Thereafter, deep second-degree burns were performed on the back of the rats by hot water. The rats were divided into two groups in a randomized fashion. The therapy group received stromal vascular fraction, whereas the control group received only physiologic serum by intradermal injection. Assessment of the burn wound healing between the groups was carried out by histopathologic and immuno-histochemical data.ResultsStromal vascular fraction increased vascular endothelial growth factor, proliferating cell nuclear antigen index, and reduced inflammation of the burn wound. Furthermore, vascularization and fibroblastic activity were achieved earlier and observed to be at higher levels in the stromal vascular fraction group.ConclusionsStromal vascular fraction improves burn wound healing by increasing cell proliferation and vascularization, reducing inflammation, and increasing fibroblastic activity.     

生长激素在成人大面积深度烧伤的应用

OBJECTIVE: To determine the wound healing effect of rHGH in adult burn patients. METHODS: 16 patients with burn wounds covering over 60% of total body surface (TBSA) were enrolled in this placebo controlled prospective study. They were comparable in nutrient intake, TBSA, and full thickness burn area. rHGH group patients were given rHGH subcutaneously in the dose of 0.3u.Kg-1 at 8 am each morning for 10 days beginning from POD 1. The control group patients were given normal saline as placebo. All the patients received scar excision within 4 days postburn, and the excision wounds were covered with autologous skin pulp grafting. Serum amino acid profile was analyzed at day 1 and day 20 post burn. Healing time of burn wound area and donor site was recorded. Wound healing rate was assessed at day 30 after day. RESULTS: 1. The healing time of autologous skin pulp grafting and donor site, and the length of hospital stay were significantly shorter in GH group patients than control group. 2. The amino acid profile showed no difference between two groups at day 1 and was significantly better in GH group at day 20. CONCLUSION: rHGH could enhance the wound healing rate, improve amino acid profile, and reduce the length of hospital stay of severe burn patients.     

Epidermal-cell-based therapy as an adjunct to healing second degree burns—A randomized controlled pilot study

BackgroundHealing of partial-thickness (2a and 2b) burns is notoriously unpredictable as far as healing time, scarring and (hypo)pigmentation is concerned. Epidermal blister grafting is an autologous grafting technique involving transfer of epidermal islands without dermal elements. Cellutome™ is an FDA-acknowledged epidermal harvesting device. This proof-of-concept study evaluates whether blister grafting of partial-thickness burns results in improved healing compared to standard acellular treatment.MethodsThis is a randomized controlled trial with 8 patients in which each patient received both treatments randomized to different burn sites. Healing was assessed at regular intervals. Twelve months after treatment, outcomes were measured with the Vancouver Scar Scale (VSS), Patient and Observer Scar Assessment Scale (POSAS), photography, spectrometry, Semmes-Weinstein Filaments, cutometry and high-resolution ultrasound.ResultsAreas treated with epidermal blister grafting healed slightly faster than acellular treatment. Epidermal treatment yielded healing with less erythema, closer to that of surrounding normal skin (p = 0.0404). Donor sites were not visible and not measurably different than normal skin.ConclusionsResults favor cellular over acellular technique for the treatment of partial-thickness (2a and 2b) burns. Significant improvement in erythema implies a higher quality healing process. Further studies should look primarily at larger areas of treatment, and larger sample size.     

几种深Ⅱ度烧伤创面处理方法的回顾及改善创面微循环的初步实验研究

目的回顾性分析几种深Ⅱ度烧伤创面的修复方法,探讨改善创面微循环对创面愈合的意义. 方法 (1)对于笔者单位烧伤患者的深Ⅱ度创面,应用削痂疗法治疗614例、磨痂疗法治疗32例、清创后异体皮覆盖86例、外用磺胺嘧啶银后创面暴露1 836例、外用中药京万红烫伤膏包扎治疗408例.统计、分析各种疗法的治疗效果.(2)制作大鼠深Ⅱ度烫伤模型.伤后5 min内分别由其尾静脉注入等渗盐水(对照组,10只)、巴曲酶(治疗组,10只),创面均外用磺胺嘧啶银.测定两组大鼠伤前及伤后0.5-72.0 h的创面皮肤血流灌注单位,计算其伤后14、18 d的创面愈合率、收缩率及创面愈合时间.用组织学方法观察两组大鼠创面愈合后的皮肤毛囊数. 结果 (1)削痂疗法术后2-3周创面愈合,其中烧伤总面积50%～79%TBSA的患者治愈率94.8%,总面积80%～98%TBSA者治愈率93.4%.磨痂疗法磨痂+异体皮覆盖术后(13.8±2.1)d创面愈合,无瘢痕形成.清创后异体皮覆盖其中82例患者术后(18.0±2.3)d创面愈合.外用磺胺嘧啶银后暴露其中1 658例患者用药后(26.0±3.2)d痂下愈合.外用京万红烫伤膏后包扎患者多有细菌感染,其中下肢创面愈合时间为(26.0±2.8)d.(2)治疗组大鼠伤后2.0-72.0 h创面局部血流灌注单位均明显高于对照组(P<0.01).伤后14、18 d,治疗组创面愈合率明显高于对照组(P<0.01),但两组创面收缩率接近(P>0.05).治疗组创面愈合时间短于对照组(P<0.01).伤后30 d,对照组大鼠真皮层中残存少量毛囊,数量明显少于治疗组(P<0.01). 结论深Ⅱ度烧伤后早期采用削痂、磨痂或清创后覆盖异体皮的方法处理创面,可减轻感染、缩短疗程、提高治愈率和愈合质量.使用巴曲酶可改善深Ⅱ度烧伤创面微循环,加快愈合速度.     

Does rapid wound closure improve survival in older patients with burns?

Seventy-five patients more than fifty years of age were admitted for treatment of burns from January 1, 1986, to December 31, 1987, to two community-hospital-based burn units. Patients were managed by a team of burn surgeons at each unit and early excision and grafting was used whenever possible in deep partial-thickness and full-thickness burns. The extent of burn was charted weekly during hospitalization and rate of wound healing was calculated using linear regression analysis. The mean total percent burn was 26.2 per cent (range, 4-85%). The overall mortality rate was 40 per cent. Mortality rate increased sharply by decade from 17.4 per cent for those aged 50-59 years to 100 per cent for the five patients age 90 and more. Excision and grafting were performed in 40 patients; 35 patients were not operated upon. Although hospitalization was somewhat longer in patients treated surgically, survival was better. Excision and grafting should be used when needed to achieve rapid wound closure in patients more than fifty years of age.     

Dual-imaging system for burn depth diagnosis

Currently, determination of burn depth and healing outcomes has been limited to subjective assessment or a single modality, e.g., laser Doppler imaging. Such measures have proven less than ideal. Recent developments in other non-contact technologies such as optical coherence tomography (OCT) and pulse speckle imaging (PSI) offer the promise that an intelligent fusion of information across these modalities can improve visualization of burn regions thereby increasing the sensitivity of the diagnosis. In this work, we combined OCT and PSI images to classify the degree of burn (superficial, partial-thickness and full-thickness burns). Algorithms were developed to integrate and visualize skin structure (with and without burns) from the two modalities. We have completed the proposed initiatives by employing a porcine burn model and compiled results that attest to the utility of our proposed dual-modal fusion approach. Computer-derived data indicating the varying burn depths were validated through immunohistochemical analysis performed on burned skin tissue. The combined performance of OCT and PSI modalities provided an overall ROC-AUC = 0.87 (significant at p < 0.001) in classifying different burn types measured after 1-h of creating the burn wounds. Porcine model studies to assess feasibility of this dual-imaging system for wound tracking are underway.     

First aid is associated with improved outcomes in large body surface area burns

BackgroundAnimal studies indicate treating burn injuries with running water (first aid) for 20 min up to 3 h after burn reduces healing time and scarring. We have previously demonstrated the benefits of first aid in minor burn injuries with respect to a reduction in wound depth, faster healing, and decreased skin grafting utilisation. The purpose of this cohort study was to assess the effect of first aid on clinical outcomes in large body surface area burn injuries (≥20%).MethodsData was prospectively collected for patients with ≥20% TBSA burns from 2004– 2018. Multivariate regression analysis was used to determine the association of adequate first aid with 8 outcomes – mortality, total length of stay, total body surface area (TBSA), percentage/proportion of TBSA that was full thickness [PFTI], TBSA grafted, number of re-grafting sessions, intensive care admission, and intensive care length of stay. Adequate first aid was defined as the application of 20 min of cool, running tap water up to 3 h following the burn injury.Findings390 patients were identified. Adequate first aid was received in 35.6% (139) of patients. There was a trend towards a reduction in mortality (OR 0.37; 95% CI 0.12–1.13; P = 0.08). Patients who received adequate first aid had a statistically significant 9.8% reduction in TBSA (95% CI −13.6% to −6.1%; P < 0.0001) as well as a 12% lower PTFI compared to patients who received inadequate first aid (95% CI −19% to −4%; P < 0.01). Whilst there was no significant effect of adequate first aid on the TBSA grafted (P = 0.37), adequate first aid was associated with a significantly less number of re-grafting sessions (95% CI −-0.29 to −0.08; P < 0.001).InterpretationAdequate first aid with 20 min of running water is associated with improved outcomes in large burn injuries. Significant benefits are seen in a reduction in TBSA, proportion of the burn wound that is full thickness, as well as decreased re-grafting. This has significant patient and health system benefits and adds to the body of evidence supporting 20 min of cooling in burns care.     

A hypothesis of the healing of deep dermal burns and the significance for treatment

Deep dermal burns heal by a combination of new connective tissue formation (granulation) and epithelialization. In deep dermal wounds, which are unhealed after 14 days of conservative treatment, epithelialization can be enhanced by abrasion either alone or combined with provision of a skin graft. Some 42 burn wounds in 25 patients treated by this method have healed quickly and with good results. This method represents a move away from the current trend of early tangential excision and grafting of burn wounds and raises the possibility of developing a regime with the advantages but not the disadvantages of early tangential excision and grafting.     

Utility of acellular allograft dermis in the care of elderly burn patients

BACKGROUND: Because skin thins with advancing age, traditional thickness skin grafts cannot always be obtained in very elderly burn patients without creating a new full-thickness wound at the skin graft donor site. MATERIALS AND METHODS: In an attempt to circumvent this problem, acellular allograft dermis (Alloderm, Life Cell Corp., The Woodlands, TX) and thin autograft (depth 0.005 inches) was used in skin grafting 10 elderly burn patients (age 78 year +/- 2, TBSA burn 17% +/- 2; mean +/- SEM) over a 1-year period. The outcome of patients receiving Alloderm was compared retrospectively to a similar group of 18 elderly patients admitted over the prior year, eight of whom underwent operative wound excision and autografting (depth 0.014 inches) without Alloderm. RESULTS: Length of hospital stay was significantly reduced in patients treated with Alloderm compared to the total group of elderly in whom selective use of operative debridement and skin grafting was used. Functional outcome was improved in those patients who underwent skin grafting regardless of operative technique. Donor site healing time was significantly reduced with Alloderm (12 days +/- 1 versus 18 days +/- 2), while graft take was similar to conventional autografting. Unfortunately, 3-month mortality remained poor regardless of operative skin grafting or technique used. CONCLUSIONS: This initial experience suggests that use of Alloderm may allow more elderly burn patients to undergo operative wound closure, thus improving functional outcome and reducing hospitalization. Unfortunately, long-term survival for very elderly burn patients remains poor.     

Microskin autografting in the treatment of burns over 70% of total body surface area: 14 years of clinical experience

Despite the fact that early excision and grafting have significantly improved burn outcomes, the management of severely burned patients whose burn size exceeds 70% total body surface area (TBSA) still represents a big challenge for burn surgeons all over the world. During the period of 1997-2010 at our centre, aggressive excision and microskin autografting were performed in 63 severely burned patients. Their burn sizes ranged from 70% to 98% TBSA with a mean of 84.9%. The average full-thickness burn was 66.3% (range, 29-94%). Thirty patients had concomitant inhalation injury. Two to 7 days after burn, these patients underwent aggressive excisions ranging from 25% to 60% TBSA and transplantation of microskin autograft overlaid with allograft. The ratios of donor-site to recipient-site surface area were between 1:6 and 1:18. Signs of epithelialization were shown within 35-55 days. The wound healing rate was 74.9% (176/235), with 51.1% of cases (120/235) healing completely and 23.8% (56/235) improving. Microskin autografting yielded an overall survival rate of 63.5%; only 23 patients died. Our clinical experience in using the microskin autografting for burn coverage suggests that the technique is very effective in covering extensive burns, and that it is particularly useful when graft donor sites are very limited due to its high utilization rate of donor site. The factors affecting the outcome of microskin autografting are discussed herein.     

Enzymatic debridement for circumferential deep burns: the role of surgical escharotomy

IntroductionCircumferential deep burns carry a high risk for a burn induced compartment syndrome. It was recently shown that an enzymatic bromelain-based debridement with Nexobrid® is a safe and efficient procedure to release pressure in deep circumferential extremity burns reducing the need for surgical escharotomy. We therefore herein aimed to analyze the conceptual relation between Nexobrid® and surgical escharotomy.Patients and methodsWe conducted a retrospective study on all patients with circumferential deep partial-thickness or full-thickness burns requiring immediate escharotomy that was either performed by surgical incision or Nexobrid®. Medical records of 792 patients that were treated at the burn center of the University Hospital Zurich between 2016 and 2021 were analyzed.ResultsOverall, 62 patients with circumferential deep partial-thickness or full-thickness burns who received preventive decompression either by Nexobrid® (N = 29) or surgical escharotomy (N = 33), were included. Whilst distribution of age, sex, BMI and type of injury showed no difference between the groups, the ABSI score, TBSA, percentage of third degree burns and mortality were significantly higher in patients who received a surgical escharotomy.ConclusionWhile the use of Nexobrid® to prevent burn induced compartment syndrome has steadily increased, surgical escharotomies were predominantly performed in severely burned patients with a high degree of full-thickness burns. Thus, higher mortality in this patient group needs to be considered with caution and is mainly attributed to the higher TBSA. Although evidence is lacking for the use of Nexobrid® for larger body areas exceeding 15%, escharotomy is also the more reliable and faster approach in such critically burned patients.