Leiden University Scholarly Publications

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Kwa, K.A.A. (2021)

Scratching beneath the surface: innovative treatment modalities for burn patients

Doctoral Thesis
In the first part of this thesis, we investigated treatments of early (burn) wound management. Our systematic review showed that convincing evidence in favor of any debridement technique in burns is lacking. We performed a prospective cohort study in patients with deep hand burns treated with enzymatic debridement that showed that hand function returns to near normal at 12 months post-burn. Our ex-vivo experiment showed that enzymatic debridement is not useful in burn wounds sustained by low temperature. We investigated the use of fibrin sealant in the fixation of skin grafts in children and concluded that it is equally effective in graft take as staples. Our study of negative pressure wound therapy (NPWT) showed that, when comparing post-, to pre-NWPT, the incidence of infection was lower, the bacterial load was higher, and that the presence of Staphylococcus aureus was higher.
In the second part we investigated pruritus in burn patients. We assessed the effect of acute...Show moreIn the first part of this thesis, we investigated treatments of early (burn) wound management. Our systematic review showed that convincing evidence in favor of any debridement technique in burns is lacking. We performed a prospective cohort study in patients with deep hand burns treated with enzymatic debridement that showed that hand function returns to near normal at 12 months post-burn. Our ex-vivo experiment showed that enzymatic debridement is not useful in burn wounds sustained by low temperature. We investigated the use of fibrin sealant in the fixation of skin grafts in children and concluded that it is equally effective in graft take as staples. Our study of negative pressure wound therapy (NPWT) showed that, when comparing post-, to pre-NWPT, the incidence of infection was lower, the bacterial load was higher, and that the presence of Staphylococcus aureus was higher.
In the second part we investigated pruritus in burn patients. We assessed the effect of acute stress symptoms on chronic itch and confirmed that age, skin grafting, and traumatic stress symptoms are significant predictors of itch following burns. Finally, we performed two trials investigating the effect of doxepin cream in the treatment of pruritus in burn patients, leading to the conclusion that the use of doxepin cream as a standard treatment is not recommended.
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Burns
Enzymatic debridement
Nexobrid
Itch
Pruritus
Negative pressure wound therapy
Fibrin sealant
All authors
Kwa, K.A.A.
Supervisor
Breederveld, R.S.
Co-supervisor
Meij-de Vries, A.
Committee
Schipper, I.B.; Middelkoop, E.; Huss, F.R.M.; Evers, A.W.M.
Qualification
Doctor (dr.)
Awarding Institution
Faculty of Medicine, Leiden University Medical Center [LUMC], Leiden University
Date
2021-10-06
ISBN (print)
9789464167924

Funding

Sponsorship
Stichting Brandwonden Research Instituut/HUMECA, Mediwound Ltd, CUTISS AG, Maatschap Chirurgen Noordwest, Nederlandse Brandwonden Stichting, BAP Medical, Smith & Nephew, Quli BV, Leander Healthcare (NexoBrid en Kerecis) en Van Wijngaarden Medical.