Use of human cadaver model in enzymatic debridement training

• Research type

  Research Study

• Full title

  The use of human cadaver model in providing systematic training for the use of bromelain-based enzymatic debridement (Nexobrid®)in thermal burn injuries

• IRAS ID

  292385

• Contact name

  Ciaran O'Boyle

• Contact email

  Ciaran.O'Boyle@nuh.nhs.uk

• Sponsor organisation

  Research and Innovation

• Duration of Study in the UK

  0 years, 7 months, 11 days

• Research summary

  Summary of Research

  The aim of this study is to determine whether a human cadaveric model is a valid method of demonstrating the use of enzymatic burn debridement for training purposes.

  For the study, a human cadaver will be obtained from the National Repository Centre, based at Nottingham University Hospitals, City Hospital campus. It will be verified that prior informed consent has been given for research by the donor.

  When carrying out the study, the cadaver skin will be marked on multiple sites for testing. One group will be assigned as ‘control’ sites. The other sites will undergo controlled thermal burn injuries of various depths. Nexobrid® will be applied to all marked sites using standard of care employed for burn patients. When the treatment period is completed, the Nexobrid® will be removed. The wounds will be assessed visually and photographically.

  The wound will be assessed for ability of Nexobrid® to debride appropriately at all sites. Appropriate burn debridement may be regarded as indicating that a cadaveric model is suitable for use as a training aid in the application of Nexobrid®. Failure to debride to an appropriate level, or excessive debridement, or significant debridement of control areas may be regarded as indicating that the cadaveric model s unsuitable for use in training.

  Summary of Results

  Burn wounds are common and can lead to significant morbidity and mortality. In order to achieve faster healing and reduce the risk of infection and scarring, the damaged, burnt skin may require removal. In the past, it was conventionally performed only with sharp blade surgical excision. However, this technique is invasive and has a high potential to sacrifice healthy tissue.

  In recent years, enzymatic debridement (ED) has emerged as a valuable technique to allow the highly selective removal of dead burned tissue whilst retaining all viable tissue. This minimises the risks of adverse scarring following burn injury.

  Currently, there is no recognised educational stimulation which may assist in educating healthcare professionals on the use of ED. Healthcare professionals have to gain experience with this technique with burned patients.

  A new study aimed to determine the feasibility of using a human cadaver to demonstrate ED as a training aid for clinical staff.

  To implement the study, a single, fresh-frozen human cadaver was used. Prior consent had been given. Burns were created by flame and scalding.

  Unburnt control sites and all burn sites had enzymatic burn debridement paste Nexobrid® applied in adherence to the local clinical protocol for treating burned patients. After the removal of Nexobrid®, wounds were assessed to determine if the cadaveric issue appeared similar to what would be expected in living burned patients and whether the technique could be viable for the training of burn care staff.

  Interestingly, we found that Nexobrid® had a similar effect upon burned cadaveric skin to what would have been expected in living burned skin. Both scalded and flame-burned sites of partial-thickness burn depth and full-thickness burn depth were debrided and could be clearly identified. Control sites exhibited no skin loss after Nexobrid® application.

  In conclusion, the study has demonstrated that fresh-frozen human cadaveric tissue is a valid means of providing training in the technique of enzymatic burn debridement, which allows advanced planning of hands-on training courses. Timetabled cadaveric courses may provide training for more students than sporadic clinical experience in acute burns units.

• REC name

  London - Surrey Borders Research Ethics Committee

• REC reference

  21/PR/0157

• Date of REC Opinion

  17 Feb 2021

• REC opinion

  Favourable Opinion