ENZYMATIC DEBRIDEMENT OF BURN WOUNDS

Principles for the use of exogenous enzymes as debriding agents for bu rn wounds are briefly discussed. These agents may be utilized in an at tempt to accelerate the removal of devitalized tissue from the wound, and this action will hopefully promote wound closure. Past experience has demonstrated that partial thickness burn wounds which close quickl y heal with less hypertrophic scar than wounds which close more slowly . Since 75 percent of the dry weight of skin is composed of collagen, exogenous collagenase preparations may prove useful for the debridemen t of burn wounds. We describe a recent clinical study of the use of a collagenase derived from the bacterium Clostridium histolylicum. Seven ty-six patients were studied at seven different United States burn cen ters. Paired partial-thickness wounds in each patient were treated wit h silver sulfadiazine or Santyl Collagenase(R) (Knell Pharmaceutical, Whippany, NJ). The use of Santyl Collagenase resulted in more rapid re moval of debris from the wound surface and more rapid epithelializatio n of the wounds, compared to silver sulfadiazine, with statistical sig nificance achieved for both end points (p < 0.001). In addition, wound s treated with Santyl Collagenase were not found to produce more disco mfort than wounds treated with silver sulfadiazine, and infection inci dences were not different. Continued study of enzymatic debriding agen ts for burn wounds will hopefully delineate techniques which will enco urage wound closure while simultaneously decreasing the intensity and expense of burn wound care.