Ultrasonografía cutánea: una herramienta objetiva para la toma de decisiones tras desbridamiento enzimático en pacientes quemados

Abstract

Background and Objective. Enzymatic debridement is an important tool in early treatment of deep burns nowadays. After it, different protocols in management of the wound bed is done in burn care units getting in some cases spontaneous healing and in others needing skin grafts. To date, there is no objective tool to ensure the success of debridement, since the remaining wound bed resembles an eschar that can generate confusion about the efficacy of the product and patient’s management The development of a reliable and objective technique for the measurement of the remaining dermis could help in the postdebridement decision making and consequently, to achieve better results. Methods. Real-time ultrasonography (US) with high-frequency probes was performed in 15 patients 12 hours after enzymatic debridement with Nexobrid® providing accurate images of the dermal remnant. We measured dermis thickness in non-burned regions and compared them with similar debrided areas. Results. All the US skin showed less skin thickness in the debrided areas than in the non-burned areas of the same patient. Despite the fact that in all cases the visual diagnosis resembled an eschar, in one case the US showed the absence of dermis and in another persistence of the eschar. Within a few days, both patients needed skin grafts. All cases with enough remaining dermis healed by spontaneous epithelialization. Conclusions. The evaluation of the wound bed with ultrasonography after enzymatic debridement is an objective method to assess the response to treatment. Also, the measurement of the remaining dermis could provide real parameters to predict chances for spontaneous epithelialization or the need for skin grafts in burned patients.