Ann. Medit. Burns Club - vol. VIII - n. 1 - March 1995

CLINICAL EXPERIENCES WITH THE APPLICATION OF REDITAC FLUID THERAPY

Pint& L.

Department of Plastic and Reconstructive Surgery and Treatment of Burns, Charles University Faculty of Medicine, Hradec Krdlové, Czech Republic

Our teaching hospital is in the clinical base of the Charles University Faculty of Medicine in Hradec Krdlov6 (Czech Republic). It cooperates in different areas with many institutions on an international scale. It is engaged both in specialization and in postgraduate studies.
The Department of Plastic and Reconstructive Surgery and Treatment of Burns has 30 beds and its own independent operating theatre. About 6,500 patients are examined and treated annually. Surgical treatment is practised in seven spheres: surgical treatment of congenital deformities, reconstructive surgery of injuries, surgery of the hand, surgery of malignancies (tumours of soft tissues), microsurgery, aesthetic surgery and burns treatment.
Important changes have been made in the treatment of burns, tramnatology and reconstructive surgery. Until June 1993 our Department was obliged to send on all critically burned patients to the Burns Centre in Prague. Now, with the initiation of Reditac fluid therapy, we are able to treat critical burns in our Department and to make use of all the advantages that this therapy provides.
I should like to thank Mr Victor G. Ryhiner and his colleagues for their help in setting up this therapy in our hospital. The classic methods of critical burn treatment are generally well known. It begins in the emergency period as shock therapy, continues in the acute period and terminates after autotransplant with early rehabilitation. Fluid therapy makes it possible to speed up this process. It prevents deepening of the burns, and its sterile environment prevents the spreading of infection in the burn areas. The microclimate ensures a safer take of autotransplants, especially on the dorsum. Reditac fluid therapy is not used only in the treatment of burn patients but is also applied in the care of polytrauma, in the treatment of soft tissue injuries and in reconstructive surgery. We have had good results using this system in pelvic fractures, in the treatment of d6collement and pressure sores, and in reconstructive surgery of tumours.Owing to the high plasticity of the support and the fact that the pressure is lower than the capillary obstruction pressure (10mm Hg without friction), the tissue lesions heal rapidly, with less need of drugs or other measures. Movement is easier and less painful for the patient.
The analgesic effect of fluid therapy is extremely useful in pelvic fractures. Rehabilitation is possible with the use of pulse therapy. It is easy to switch over from pulse therapy to ordinary treatment. Pulse therapy makes it possible to stabilize the burn patient and to continue routine hydrotherapy, classic rehabilitation being introduced later.
Pulse therapy restricts the risk of contractures in critical burns and polytrauma and of pressure sores, when the patient is obliged to remain in bed for a long period of time.
The results of progressive Reditac fluid therapy in our Department are as follows:

1. It inactivates bacterial flora on injured skin surfaces and tissues even when a dressing is used.

2. It has a fixative function in skeleton fractures, e.g. pelvic fractures (pulse therapy).
3. It reduces the risk of contractures (pulse therapy).
4. It considerably reduces recovery time.
5. It shortens the rehabilitation period.

6. The possibility of adjusting the working level facilitates examination, treatment and general care of the patient.

It follows that the use of fluid therapy reduces the cost of treatment by 35-40%. After the treatment of some five to seven patients we can expect an economic benefit, while the human aspects of the therapy can hardly be quantified.
Below are some clinical experiences regarding the application of progressive fluid therapy. On 8 June 1993 a woman was brought to the Plastic Surgery Department of the University Hospital in Hradec KrOove. She had severe third-degree burns in a total body surface area of 42%. The accident happened when she was using toluene as fuel in order to destroy Colorado beetles. She arrived 2.5 hours after the accident, in an air ambulance from Tutnov.
Since the Plastic Surgery Department did not then have an effective burns therapy at its disposal, the patient was treated for the time being on a classic anti-decubitus mattress. Meanwhile the University Hospital in Hradec Kr6lov6 made an appeal to Reditac BV in Holland, in order to administer Reditac fluid therapy to the patient.
The third-degree burns were concentrated in the legs, genitals, thorax and arms. As there were circular injuries in the left arm and left leg, we performed relaxing incisions.
The treatment of the open skin surfaces was performed according to the classic method. After necrectomy, we applied GPG12 to the incisions, instead of Demazine. GPG12 is a new type of burn cream, produced by Veverska Bytiska. It does not contain silver and the antibacteriological element is chlorhexidine. The cream has the same effect as Demazine.
The skin of the left groin was removed for the bacteriological culture. The culture contained large colonies of Pseudomonas, Acinetobacter, Staphylococcus epidermis and spore-forming microbes. On account of a severe chronic infection and the presence of Candida, we used Ciprobay (Bayer) Nisoral ex Oxacillin, after consultation with our Antibiotic Centre. The patient had high fever.
Reditac fluid therapy with the special odparovaci sheet was finally applied on 5 July 1993. This sheet has a permeability of 5 p, all the fluid medicines applied maintain their activity without disappearing in the microspheres, and the dehydration of skin deformations is not interrupted.
Treatment with this therapy became effective in six days. Within 24 hours the cultivation of the colonies of Pseudomonas, spore-forming microbes, Candida and Acinetobacter was negative, and within five days all Pseudomonas bacteria were eliminated from practically all the injured skin surfaces. Cultivation from the buttocks was completely negative, as also from the limbs.
After ten days of this therapy, we initiated pulse therapy with an interval adjustment of I sec maximum fluidization and 4 min fixation of the body, with a sterile air circulation at a relative humidity of 40%. The interval was gradually increased to 9.9 min. Pulse therapy considerably reduced muscle contraction.
We have found that the treatment of patients with third-degree burns with Reditac fluid therapy takes ± 14 days, after which the classic after-treatment can be initia~ ted using for example the low-air-loss mattress or the antidecubitus mattress.
The second patient treated with this therapy was a 32year-old man who was knocked off his bicycle by a truck, sustaining a pelvic fracture and an extensive ddeollement. The skin and true skin were pratically ripped off over the entire width from thefasciae on the back. Klebsiella pneumoniae, Proteus mirabilis and Aeruginosa were established on the open skin surfaces.
On 11 August 1993 the patient was put on therapy for seven days: three days with fluidization and four days with pulse therapy. After termination of the therapy, the smear was completely negative.
Both the patients had a very positive experience with this treatment, including pulse therapy. The method proved to be extremely suitable, especially for burns, because of its unique characteristic feature of completely eliminating all bacterial contamination, leading to more rapid healing.
Reditac fluid therapy also did good service in polytraumas and pelvic fractures. Such accidents are frequent occurrences and they present many problems in their treatment because of the intense pain that they cause. Reditac fluid therapy allows very easy handling of the patient and it is also possible to apply various fixation levels. During therapy the patients hardly experienced any pain while they were being treated. When pulse therapy was given, no pain or unpleasant feeling was experienced.
Our first experience with the Reditac fluid therapy was thus exceptionally favourable. Manipulation was very simple and the loss of microspheres was a maximum of 150 gm after about one week's treatment. Pulse therapy was an important aspect as it prevents avoids muscle contraction.
Reditac fluid therapy was also successfully administered to patients with tissue deformations in our Traumatology Department.