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... 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. Show less
Kwa, K.A.A.; Goei, H.; Breederveld, R.S.; Middelkoop, E.; Vlies, C.H. van der; Baar, M.E. van 2019
Objective: To provide a complete overview of all burn debridement techniques studied in recent literature and to find the best evidence with regard to efficiency and safety.Method: A systematic... Show moreObjective: To provide a complete overview of all burn debridement techniques studied in recent literature and to find the best evidence with regard to efficiency and safety.Method: A systematic review was performed. Searches were conducted in electronic databases such as PubMed, Embase, Cochrane, CINAHL, Web of Science, and Academic Search Premier. All studies published from 1990 onwards, on the efficiency and/or safety of burn debridement techniques in patients with thermal burn injuries of any age, were included. Primary outcomes were time to complete wound healing and time to complete debridement. Randomized trials were critically appraised.Results: Twenty-seven studies, including four randomized clinical trials, were included. Time to wound healing in the conventional tangential excision (seven studies), hydrosurgery (eight studies), enzymatic debridement (eleven studies), and shock waves group (one study) ranged from 13-30, 11-13, 19-33, and 16 days, respectively. Time to complete debridement ranged from 5-10, 4-23, and 1-9 days, respectively. Furthermore, secondary outcomes (including grafting, mortality, and scar quality) were compared between the debridement categories.Conclusion: Convincing evidence in favor of any of these techniques is currently lacking. Future studies regarding (new) debridement techniques need to use standardized and validated outcome measurement tools to allow improved standardization and comparisons across studies. (C) 2019 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. Show less
The aim of this thesis is to understand the epidemiology, treatment and outcomes of specialized burn care in The Netherlands. This thesis is mainly based on historical data of the burn... Show more The aim of this thesis is to understand the epidemiology, treatment and outcomes of specialized burn care in The Netherlands. This thesis is mainly based on historical data of the burn centre in Rotterdam from 1986, combined with historical data from the burn centres in Groningen and Beverwijk from 1995-2009 and the common Dutch Burns Registration (NBR) R3 from 2009. This dissertation consists of three parts: part 1: Epidemiology Part 2: Treatment part 3: Results Part 1 Epidemiology In two chapters trends in severe burns in the Netherlands and epidemiology of children admitted to the Dutch Burn Centres and changes in referral influence admittance rates in burn centres are described . Part 2 Treatment Chapter 4 describes the use of modern wound dressings (hydrofibres) where a reduction in the number of operations to be carried out was seen in comparison with the ointment treatment with silver sulfadiazine in second degree burns. Chapter 5 describes the results of bacteriological cultures at admission, which is used an extensive database from 1987. Part 3 Results In 3 chapters the predictive value of a scoring system and the mortality in burn centers in The Netherlands are described. Show less
