WOUND-HEALING - SPECIAL CONSIDERATIONS IN THE BURN PATIENT

Retention of the remnants of burned skin (eschar) and the formation of necrotic debris resulting from wound drainage and secretions (pseudoe schar) in burn wounds frequently interfere with the wound healing proc ess. In addition, devitalized tissue and secretions at the wound surfa ce are a nidus for infection. Native proteolytic enzymes in tissues or proteases produced by colonizing bacteria promote the separation of e schar and debris from the wound surface. However, since this process i s lengthy, aggressive wound care is utilized to debride adherent and l oose debris until the decision is made to either excise and graft the wound or await epithelialization. While native proteolytic enzymes or those produced by colonizing bacteria eventually affect eschar separat ion, the use of exogenous enzymes for wound debridement may accelerate wound cleaning and healing. Collagenase ointment, containing a collag enase derived from the fermentation of Clostridium histolyticum, posse sses the unique ability to digest native and denatured collagen in nec rotic tissue and has achieved wide-spread acceptance for the treatment of dermal ulcers. Since collagen accounts for 75% of the dry weight o f skin tissue, the ability of collagenase to digest collagen at physio logical pH and temperature ranges makes it a potentially important deb riding agent for burn wounds. In a prospective, randomized, multicente r trial of 79 patients with partial-thickness burns, the efficacy of c ollagenase ointment for debriding wounds was compared to standard topi cal therapy. Endpoints were days to clean wound (absence of retained d ebris) and days to epithelialization. When paired treatment sites were compared within each patient, proportionately more of the collagenase -treated sites cleaned and healed before similar burn sites treated wi th silver sulfadiazine. The results of this multicenter study suggest that the use of collagenase for treatment of partial thickness burn wo unds is efficacious and minimizes discomfort for the patient.