The Experts below are selected from a list of 234 Experts worldwide ranked by ideXlab platform
Christoph Hirche - One of the best experts on this subject based on the ideXlab platform.
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feasibility and safety of enzymatic debridement for the prevention of operative Escharotomy in circumferential deep burns of the distal upper extremity
Surgery, 2019Co-Authors: Sebastian Fischer, Valentin Haug, Yannick Diehm, Patrick Rhodius, Tomke Cordts, Volker J Schmidt, Dimitra Kotsougiani, Johannes Horter, Ulrich Kneser, Christoph HircheAbstract:Background Burn-induced compartment syndrome is a severe sequela after circumferential burns of the extremities and is avoidable by immediate release of the underlying pressure under the eschar. Although the current gold standard is operative Escharotomy, this procedure carries considerable morbidity. Our study evaluates the safety and effectiveness of immediate enzymatic debridement to prevent the need for operative Escharotomy because of burn-induced compartment syndrome in selected patients. Patients and Methods From 2015 to 2017, all patients suffering from deep circumferential burns of the upper extremities requiring operative Escharotomy were potential candidates for the treatment algorithm evaluated by this study. Exclusion criteria involved burn trauma > 12 hours, clinically established burn-induced compartment syndrome, intolerance to the enzymatic debriding agent, dry burns requiring presoaking, as well as blast and electrical injuries requiring fasciotomy or carpal tunnel release. All patients with the inclusion criteria received enzymatic debridement with Nexobrid immediately after admission to our burn center. Enzymatic debridement was applied according to the manufacturer's recommendations. After enzymatic debridement, extremities were revisited every 2 hours for 24 hours to determine the need for conversion to conventional operative Escharotomy. The indication for and time to skin grafting was reviewed, and functional outcomes assessed during follow-up examination. Results Included in this sturdy were 13 patients with 20 burned upper extremities. Enzymatic debridement provided a sufficient eschar removal in all patients. Conversion to conventional operative Escharotomy was thus not necessary in any patient. Secondary skin grafting was required in 9 patients. Functional outcomes were favorable 11.9 months after burn trauma. Conclusion If the specific contraindications are respected, enzymatic debridement is safe and effective for the prevention of burn-induced compartment syndrome after deep circumferential burns at the upper extremity, and thus making operative Escharotomy unnecessary.
Iain S Whitaker - One of the best experts on this subject based on the ideXlab platform.
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a novel cost effective Escharotomy simulator and trainee assessment
Burns, 2008Co-Authors: T Potokar, Shobha Chamania, Parkash Lohana, Patricia Elaine Price, Iain S WhitakerAbstract:Over the last two decades, virtual reality, haptics, simulators, robotics, and other "advanced technologies" have emerged as important innovations in medical learning and practice. In the 21st century, however, it is important to continue to develop simple teaching aids which are available to large audiences in low and middle-income countries. We present a simple 'Escharotomy simulator' which has been well received, resulting in an increase in knowledge, and an increase in confidence to carry out the procedure.
John Ioannovich - One of the best experts on this subject based on the ideXlab platform.
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Early Escharotomy as a Measure to Reduce Intraabdominal Hypertension in Full-Thickness Burns of the Thoracic and Abdominal Area
World Journal of Surgery, 2003Co-Authors: Demosthenis Tsoutsos, Stavroula Rodopoulou, Evangelos Keramidas, Miltiadis Lagios, Konstantinos Stamatopoulos, John IoannovichAbstract:Intraabdominal hypertension (IAH) can occur in critically ill patients who have undergone surgery, who have required fluid resuscitation after intraabdominal operations, or whose abdominal surgical wound closure was under tension. If IAH remains unrelieved, it can lead to development of the abdominal compartment syndrome (ACS). The latter presents with severe cardiorespiratory and urinary symptoms such as hypotension, hypoventilation, and oliguria, and it can become fatal if it is not diagnosed early and treated properly. Moreover, IAH has been documented in the context of major burns, complicating the initial resuscitation of these patients. This study was set up to investigate the role of full-thickness burns of the thoracic and abdominal areas in IAH during the early resuscitation period, to determine whether Escharotomy could influence its levels. During the past 2 years 10 burn patients were enrolled in this study, as they fulfilled the necessary criteria: >35% total body surface area (TBSA) full-thickness burn affecting the anterior, lateral, and most of the posterior surface of the thorax and abdomen (torso), no respiratory mechanical support at admission, and initial evaluation at another facility and transfer to our burn center 2–6 h postburn. Upon admission, the following parameters (indicative of intraabdominal hypertension, IAH) were measured: bladder pressure and gastric pressure. Also, we monitored inferior vena cava pressure, and as a routine, central venous pressure, systolic blood pressure, and arterial blood gases. Elevated intraabdominal pressure to hazardous levels was documented in all patients included in our study. The same Escharotomy pattern was performed in every case, and 5–10 min after the procedure all measurements were repeated. Immediate improvement of all the parameters measured was recorded, and the alterations were found statistically significant. These results were indicative of significant relief of the elevated intraabdominal pressure in all patients after Escharotomy, as well as the efficacy of the procedure. It is thus demonstrated that full-thickness burns of the thoracic and abdominal areas can cause a significant early increase in intraabdominal pressure that, if left untreated, can lead to the development of ACS. However, the application of simple decompression techniques can offer remarkable, immediate, and often lifesaving results and is absolutely indicated for this reason, as well as for its well-known beneficial effects on respiratory function.
Sebastian Fischer - One of the best experts on this subject based on the ideXlab platform.
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feasibility and safety of enzymatic debridement for the prevention of operative Escharotomy in circumferential deep burns of the distal upper extremity
Surgery, 2019Co-Authors: Sebastian Fischer, Valentin Haug, Yannick Diehm, Patrick Rhodius, Tomke Cordts, Volker J Schmidt, Dimitra Kotsougiani, Johannes Horter, Ulrich Kneser, Christoph HircheAbstract:Background Burn-induced compartment syndrome is a severe sequela after circumferential burns of the extremities and is avoidable by immediate release of the underlying pressure under the eschar. Although the current gold standard is operative Escharotomy, this procedure carries considerable morbidity. Our study evaluates the safety and effectiveness of immediate enzymatic debridement to prevent the need for operative Escharotomy because of burn-induced compartment syndrome in selected patients. Patients and Methods From 2015 to 2017, all patients suffering from deep circumferential burns of the upper extremities requiring operative Escharotomy were potential candidates for the treatment algorithm evaluated by this study. Exclusion criteria involved burn trauma > 12 hours, clinically established burn-induced compartment syndrome, intolerance to the enzymatic debriding agent, dry burns requiring presoaking, as well as blast and electrical injuries requiring fasciotomy or carpal tunnel release. All patients with the inclusion criteria received enzymatic debridement with Nexobrid immediately after admission to our burn center. Enzymatic debridement was applied according to the manufacturer's recommendations. After enzymatic debridement, extremities were revisited every 2 hours for 24 hours to determine the need for conversion to conventional operative Escharotomy. The indication for and time to skin grafting was reviewed, and functional outcomes assessed during follow-up examination. Results Included in this sturdy were 13 patients with 20 burned upper extremities. Enzymatic debridement provided a sufficient eschar removal in all patients. Conversion to conventional operative Escharotomy was thus not necessary in any patient. Secondary skin grafting was required in 9 patients. Functional outcomes were favorable 11.9 months after burn trauma. Conclusion If the specific contraindications are respected, enzymatic debridement is safe and effective for the prevention of burn-induced compartment syndrome after deep circumferential burns at the upper extremity, and thus making operative Escharotomy unnecessary.
T Potokar - One of the best experts on this subject based on the ideXlab platform.
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a novel cost effective Escharotomy simulator and trainee assessment
Burns, 2008Co-Authors: T Potokar, Shobha Chamania, Parkash Lohana, Patricia Elaine Price, Iain S WhitakerAbstract:Over the last two decades, virtual reality, haptics, simulators, robotics, and other "advanced technologies" have emerged as important innovations in medical learning and practice. In the 21st century, however, it is important to continue to develop simple teaching aids which are available to large audiences in low and middle-income countries. We present a simple 'Escharotomy simulator' which has been well received, resulting in an increase in knowledge, and an increase in confidence to carry out the procedure.