gms | German Medical Science

Introduction: Early tangential excision and skin grafting with STSG is the treatment of choice in deep dermal burns in order to increase survival rates, optimize functional and esthetic outcome and reduce costs. In contrast to clearly full thickness burns, differentiation by clinical assessment of partial thickness burns which may or may not be surgically treated is a huge problem even for experts in burn care (estimated expert accuracy <65%). To avoid unnecessary surgery for these burns, the decision for surgery is often delayed for ten to fourteen days, which is not cost-effective in the current difficult economic environment. In this specific category of deep burns, laser Doppler imaging (LDI) revealed the need for surgery with an accuracy of >96%, and this from 48 hours post burn.

Methods: Since the introduction of LDI in 2000 in our Gent burn centre, approximately 100 patients were scanned on different days post burn for study reasons and more than 3000 patients between 48 and 96 hours post burn. Patients were scanned as part of a mono- or multi-centre study and as part of our standard treatment regimen.

Results: The studies resulted in five publications about: burn depth assessment, determination of optimal time for scanning, derivation and validation of a new color palette for easy interpretation of scan results and a multi-centre study about fast and easy laser Doppler line-scanning. Absolutely necessary was the setup of a specialist team allowing complete integration of LDI in the standard treatment for all our burn patients. The use of color coded maps produced by LDI, clearly indicating the deep burned areas and presented on wide screens in the operating theatre, is now common practice for early and selective surgery.

Conclusion: State of the art burn care nowadays should involve early accurate burn assessment by LDI. Objective and highly accurate prediction of the indications for selective enzymatic debridement or surgical treatment with early excision and grafting are essential as it will result in: improved planning, less surgery, higher survival rates, better esthetic and functional outcome and overall reduction of costs.