Decreased Hypertrophic Burn Scar Formation with Collagenase
Decreased Hypertrophic Burn Scar Formation with Collagenase
Hypertrophic scar formation in the burn wound is a major concern, as it may be associated with a loss of function as well as an undesirable cosmetic result. The longer a wound is open, the greater the risk of scar formation. In theory, expediting removal of necrotic tissue from a wound allows for more rapid wound closure and less scar production. In 1994, the authors' burn center began using an enzymatic debriding agent (collagenase) in the treatment of superficial burn wounds. The use of this enzyme expedited debridement of the wounds and resulted in more rapid closure of the wounds. In addition, less hypertrophic scar formation was observed. To confirm the latter finding, a retrospective study was performed. Wounds that did not require skin grafting were included in the study. A group of 225 patients debrided with saline wet-to-dry dressings (19891992) was identified and compared to 207 patients treated with collagenase (19941997). In the saline wet-to-dry group, 46 patients (20.4%) developed significant scar post closure of the wounds, compared to only 19 patients (9.2%) treated with collagenase. This difference was statistically significant (p < 0.001).
Scar control is a major concern in burn wound management. When scarring occurs, the outcome may be associated with a loss of function or an undesirable cosmetic result. The functional problems may be severe enough to result in the inability to perform one's usual work tasks. An unacceptable cosmetic result may lead to psychosocial concerns.
Early wound closure results in less hypertrophic scarring. Early excision and grafting of deeper injuries expedites wound closure. A significant challenge remains in how to avoid hypertrophic scar formation in partial-thickness wounds that are allowed to heal spontaneously.
In 1994, the authors' institution began using an enzymatic debriding agent, collagenase, in the treatment of superficial burn wounds. Collagenase is a metalloproteinase derived from the fermentation of Clostridium histolyticum. Collagenase has been shown to expedite wound debridement. Furthermore, with earlier debridement to a clean dermis, re-epithelization occurs faster. The authors believe that a decrease in hypertrophic scar formation also occurs.
The purpose of this study was to compare the incidence of hypertrophic scar formation in patients with partial-thickness burns not treated with collagenase to those treated with collagenase. The authors' intent was to report an observation that needs further investigation. The hypothesis for this study was that the use of collagenase in the partial-thickness burn wound decreased the incidence of hypertrophic scar formation.
Hypertrophic scar formation in the burn wound is a major concern, as it may be associated with a loss of function as well as an undesirable cosmetic result. The longer a wound is open, the greater the risk of scar formation. In theory, expediting removal of necrotic tissue from a wound allows for more rapid wound closure and less scar production. In 1994, the authors' burn center began using an enzymatic debriding agent (collagenase) in the treatment of superficial burn wounds. The use of this enzyme expedited debridement of the wounds and resulted in more rapid closure of the wounds. In addition, less hypertrophic scar formation was observed. To confirm the latter finding, a retrospective study was performed. Wounds that did not require skin grafting were included in the study. A group of 225 patients debrided with saline wet-to-dry dressings (19891992) was identified and compared to 207 patients treated with collagenase (19941997). In the saline wet-to-dry group, 46 patients (20.4%) developed significant scar post closure of the wounds, compared to only 19 patients (9.2%) treated with collagenase. This difference was statistically significant (p < 0.001).
Scar control is a major concern in burn wound management. When scarring occurs, the outcome may be associated with a loss of function or an undesirable cosmetic result. The functional problems may be severe enough to result in the inability to perform one's usual work tasks. An unacceptable cosmetic result may lead to psychosocial concerns.
Early wound closure results in less hypertrophic scarring. Early excision and grafting of deeper injuries expedites wound closure. A significant challenge remains in how to avoid hypertrophic scar formation in partial-thickness wounds that are allowed to heal spontaneously.
In 1994, the authors' institution began using an enzymatic debriding agent, collagenase, in the treatment of superficial burn wounds. Collagenase is a metalloproteinase derived from the fermentation of Clostridium histolyticum. Collagenase has been shown to expedite wound debridement. Furthermore, with earlier debridement to a clean dermis, re-epithelization occurs faster. The authors believe that a decrease in hypertrophic scar formation also occurs.
The purpose of this study was to compare the incidence of hypertrophic scar formation in patients with partial-thickness burns not treated with collagenase to those treated with collagenase. The authors' intent was to report an observation that needs further investigation. The hypothesis for this study was that the use of collagenase in the partial-thickness burn wound decreased the incidence of hypertrophic scar formation.
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