Enzymatic debridement for circumferential deep burns: the role of surgical escharotomy.

INTRODUCTION: Circumferential deep burns carry a high risk for a burn induced compartment syndrome. It was recently shown that an enzymatic bromelain-based debridement with Nexobrid® is a safe and efficient procedure to release pressure in deep circumferential extremity burns reducing the need for surgical escharotomy. We therefore herein aimed to analyze the conceptual relation between Nexobrid® and surgical escharotomy. PATIENTS AND METHODS: We conducted a retrospective study on all patients with circumferential deep partial-thickness or full-thickness burns requiring immediate escharotomy that was either performed by surgical incision or Nexobrid®. Medical records of 792 patients that were treated at the burn center of the University Hospital Zurich between 2016 and 2021 were analyzed. RESULTS: Overall, 62 patients with circumferential deep partial-thickness or full-thickness burns who received preventive decompression either by Nexobrid® (N = 29) or surgical escharotomy (N = 33), were included. Whilst distribution of age, sex, BMI and type of injury showed no difference between the groups, the ABSI score, TBSA, percentage of third degree burns and mortality were significantly higher in patients who received a surgical escharotomy. CONCLUSION: While the use of Nexobrid® to prevent burn induced compartment syndrome has steadily increased, surgical escharotomies were predominantly performed in severely burned patients with a high degree of full-thickness burns. Thus, higher mortality in this patient group needs to be considered with caution and is mainly attributed to the higher TBSA. Although evidence is lacking for the use of Nexobrid® for larger body areas exceeding 15%, escharotomy is also the more reliable and faster approach in such critically burned patients.

Comparison of forensic photo-documentation to a photogrammetric solution using the multi-camera system "Botscan".

As forensic science technologies progress, digital photography has become outdated for certain documentations that require exact measurements. Recording three-dimensional objects on a two-dimensional photograph leads to a potential loss of relevant information. Photogrammetry has been utilized to record persons, objects or crime scenes and prevents this loss. Photogrammetry enables accurate documentation and visualization of events or matching of injuries and injury-causing instruments. To reduce inaccuracies during photogrammetric recording, a multi camera device, Botscan by Botspot, can be used to record living persons in three-dimensional space (3D). The device can record a full body in a fraction of a second, which leads to a significant reduction of inaccuracies due to movement. Photogrammetric measurements were compared with measurements from forensic photographs to evaluate the applicability of this device for medical forensic documentation of injuries. For this purpose, a mannequin fitted with different types of artificial injuries was used as an example. The results showed that the photogrammetric measurements obtained using the software Agisoft PhotoScan were more accurate than the measurements from the forensic photographs.