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
SUMMARY. A description is given
of the treatment of burn patients based on Reditac fluid therapy, which presents a number
of advantages. This method can also be used in cases of polytrauma, d6collement and in
reconstructive surgery. Two clinical cases are described. Reditac fluid therapy can be
effectively combined with pulse therapy, which reduces the risk of contractures.
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:
It inactivates
bacterial flora on injured skin surfaces and tissues even when a dressing is used.
- It has a fixative function in skeleton
fractures, e.g. pelvic fractures (pulse therapy).
- It reduces the risk of contractures (pulse
therapy).
- It considerably reduces recovery time.
- It shortens the rehabilitation period.
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.
RESUME.
L'auteur présente son expérience avec la thérapie liquide Reditac, qui offre divers
avantages. Cette méthode peut être aussi uti-
lisée dans les polytraumatismes, les décollements et la chirurgie réparatrice. Deux cas
cliniques sont décrits. La thérapie liquide Reditac
peut être associée avec succùs à la thérapie à vibration, qui réduit le risque de
contractures.
BIBLIOGRAPHY
- Boswick J.A. Jr: Comprehensive rehabilitation after
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1974.
- Fox C.L. Jr: Silver sulfadiazine: a new topical
therapy for Pseudomonas in burns. Arch. Surg., 96: 184-8, 1968.
- Frank D.H., Donaldi L.C.: Inhibition of wound
contraction: comparison of full-thickness skin grafts, Biobrane, and aspartate membranes.
Ann. Plast. Surg., 14: 103-10, 1985.
- Gray D.T., Pine R,W., Harnar T.J. et al.: Early
surgical excision versus conventional therapy in patients with 20 to 40 per cent burns: a
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- Heggers J.P., Velanovich V., Robson M.C. et al.:
Control of bum 12. Pruitt B.A. Jf: The diagnosis and treatment of infection in the burn
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last 50 years. NL-9001211 (The Netherlands).Burns, 17: 329-34, 1991.
EUROPEAN BURNS
ASSOCIATION 6TH INTERNATIONAL
CONGRESS
will be held from 13 to 15 September 1995
in Verona, Italy
The scientific programme includes:
Burns in the elderly
Immunology and topical treatment of lesion
Face and hand burns (immediate and long-term results)
For further information contact:
Scientific Secretariat:
Prof. Dino Barisoni, Divisione di Chirurgia Plastica V
0spedale di Borgo Trento 37126 Verona - Italy
Tel. 0039/45/8072412 - Fax 0039/45/8072069
Meeting Venue:
Exhibition Centre
Viale del Lavoro, 8/a - 37135 Verona - Italy
Organizing Secretariat:
Errebi Congressi dept. of Renbel Travel s.r.l.
Via Monte Pasubio, 8 - 37126 Verona - Italy
Tel. 0039/45/916577 - Fax 0039/45/912903 |
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