Edmondson SJ, Ali Jumabhoy I, Murray A, et al.
Burns : journal of the International Society for Burn Injuries. Date of publication 2018 Feb 15;volume ():.
1. Burns. 2018 Feb 15. pii: S0305-4179(18)30034-2. doi: 10.1016/j.burns.2018.01.012.
[Epub ahead of print]
Time to start putting down the knife: A systematic review of burns excision tools
of randomised and non-randomised trials.
Edmondson SJ(1), Ali Jumabhoy I(2), Murray A(2).
Author information:
(1)Department of Burns, Plastic & Reconstructive Surgery, Stoke Mandeville
Hospital, Mandeville Road, Aylesbury, Buckinghamshire HP21 8AL, United Kingdom.
Electronic address: Sarah.EdmondsonST5@chelwest.nhs.uk.
(2)Department of Burns, Plastic & Reconstructive Surgery, Stoke Mandeville
Hospital, Mandeville Road, Aylesbury, Buckinghamshire HP21 8AL, United Kingdom.
AIMS: Dermal preservation during acute burn excision is key to obtaining superior
healing/scar outcomes, however, determining the most appropriate excision tool is
an ongoing challenge. Novel tool development means the knife is no longer our
only option, yet for the majority it remains the gold standard. This systematic
review aims to evaluate evidence for burns excision approaches
(knife/hydrosurgery/enzymatic).
METHODS: CENTRAL, EMBASE, MEDLINE (1946-2017) were searched with MeSH terms:
'debridement', 'burns', 'sharp', 'enzymatic', 'hydrosurgery'. Relevant randomised
control trials (RCTs)/non-randomised controlled case series/trials were
extracted/analysed. In vitro/burn non-specific studies were excluded. Main
methodological parameters were intervention/excision efficacy.
RESULTS: Eighteen articles met inclusion criteria (n=7148): three were RCTs,
involving comparator enzymatic (NexoBrid™ (EDNX)) or hydrosurgical (Versajet™)
excision to surgical Standard of Care. Both showed statistically significant
decreased need for excisional excision and auto-grafting by viable tissue
preservation allowing spontaneous healing by epithelialisation.
CONCLUSION: Level 1 Evidence comparing excision modalities for acute burns is
sparse. Although early excision with a knife is still often considered best
practice, there is no tool choice consensus or robust comparison with alternate,
possibly superior, tools. EDNX or Versajet™ should be considered alternatively.
Further RCTs are indicated, with regards final scar outcomes and to allow
consensus within current evidence.
Copyright © 2018 Elsevier Ltd. All rights reserved.
DOI: 10.1016/j.burns.2018.01.012
PMID: 29456099
