Optimization Of Debridement Depth That Results In Complete Graft Take For Porcine Burn Wounds
Randolph Stone, II, David Larson, John Wall, Christine Kowalczewski, Shanmugasundaram Natesan, Robert Christy.
US Army Institute of Surgical Research, Fort Sam Houston, TX, USA.
Background: The current standard of care for burn wound management involves removal of necrotic tissue to a bleeding wound bed then application of a skin graft depending on the depth of injury. However, the debridement procedure is difficult, time consuming, and can result in hypertrophic scarring if too much tissue is removed thus resulting in a deeper wound. The purpose of this study was to determine the optimal amount of debridement necessary to result in successful graft take on porcine burn wounds. Methods: Deep partial and full thickness 5x5 cm burn wounds were created on the dorsum of six anesthetized Yorkshire pigs using appropriate pain control methods. After 4 days, the necrotic eschar was debrided via a dermatome to three depths (0.030”, 0.060”, 0.090”) and a meshed split thickness skin graft was applied. Graft success (defined as >70% graft take) was assessed on days 7 and 14. Results: Approximately 65% of wounds with the least debridement amount resulted in graft failure. No differences in bacterial counts were detected in the post-debrided wounds. Laser speckle imaging indicated no differences in the burn contact times immediately post-burn but significant differences were detected at the pre-debridement time point when comparing the burn depths. After combining all wounds into either graft success vs. failure, laser speckle imaging detected a significantly higher blood flow in post-debrided wounds for the wound beds that resulted in graft success. Conclusions: This study allowed for the creation of a model to duplicate the clinical situation of inadequate debridement in burn wounds resulting in graft failure. Other potential reasons such as infection and mechanical shearing were ruled out as contributors in the observed graft failure. Most intriguing, laser speckle imaging was able to differentiate between the wounds that were adequately debrided and those where necrotic tissue remained; thereby, providing clinicians with a non-invasive technique that could help determine when to graft.
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