[Implementation of treatment by enzymatic debridement in burns: results of an interprofessional German-speaking expert workshop]. / Implementierung der Behandlung durch enzymatisches Debridement bei Verbrennungen ­ Ergebnisse eines interprofessionellen, deutschsprachigen Expertenworkshops.

INTRODUCTION: Since its introduction in 2013 Bromelain-based Enzymatic Debridement (ED) is increasingly used in burn centers. Published evidence shows its efficiency in eschar removal as well as a superiority in blood loss and necessity of further surgical procedures compared to standard-of-care. While the procedure is safe and shows reliable results in experienced hands, some practical and logistical issues must be challenged that are not described sufficiently in available literature. METHOD: A multi-professional panel, consisting of experienced users of ED from German-speaking burn units has been invited to an expert workshop. Topics concerning indication, definition of treatment pathways, practical issues, post-treatment and handling of complications have been coordinated in advance to allow discussion during the workshop. RESULTS: To each topic practical recommendations were developed and consented. Summarizing key messages have been additionally highlighted. They aim on helping to achieve optimal results after establishing the technique by new users as well as optimizing results by experienced users. Amongst others, the resulting recommendations deal with indications for ED beyond the classic domain, different treatment pathways depending on burn depth and primary result after ED with adapted post-treatment, management of treatment failure and implementation of infrastructural conditions. DISCUSSION: While efficiency of ED as well as superiority in some aspects of treatment of burn wounds could be shown in available literature, user-oriented recommendations for practical implementation are scarce. Although the recommendations and experts opinions published here are only partly evidenced based, they are still based on the pooled experienced of the panelists that easily outnumbers the cases published in literature so far and allow valuable support for a successful implementation of the technique.

The effect of moisture on the shear bond strength of gold alloy rods bonded to enamel with a self-adhesive and a hydrophobic resin cement.

The aim of this in vitro study was to investigate the influence of enamel moisture on the shear bond strength (SBS) of a hydrophobic resin cement, Maximum Cure (MC), and a self-adhesive resin cement, Multilink Sprint (MLS), after etching of the enamel. Forty cylindrical gold alloy rods were used to simulate the Incognito lingual bracket system. They were bonded to the enamel of 40 human teeth embedded in self-cured acrylic resin. Twenty were bonded with MC (10 on dry and 10 on wet enamel) and 20 with MLS (10 on dry and 10 on wet enamel). The SBS of MC and MLS was determined in a universal testing machine and the site of bond failure was defined by the adhesive remnant index (ARI). A Kruskal-Wallis test was performed followed by Games-Howell post hoc pairwise comparison tests on the SBS results (P < 0.05) and a chi-square test was used for the analysis of ARI scores (P < 0.05). On dry enamel, no significant differences between MC (58 +/- 5 MPa) and MLS (64 +/- 13 MPa) were noted. On wet enamel, the adherence of MC (6 +/- 8 MPa) and MLS (37 +/- 13 MPa) significantly decreased but to a lesser extent for MLS. The ARI scores corroborated these results. In conclusion, MC did not tolerate moisture. MLS was also affected but maintained sufficient adherence.