Bromelain-based enzymatic burn debridement: Spanish multidisciplinary consensus

Abstract

Background Bromelain-based enzymatic debridement is gaining increased interest from burn specialists in the last few years. The objective of this manuscript is to update the previous, first Spanish consensus document from 2017 (Martínez-Méndez et al. 43:193–202, 2017), on the use of enzymatic debridement with NexoBrid® in burn injuries, adding the clinical experience of a larger panel of experts, integrating plastic surgeons, intensivists, and anesthesiologists. Methods A consensus guideline was established by following a modified Delphi methodology of a 38-topic survey in two rounds of participation. Items were grouped in six domains: general indication, indication in critical patients, pain management, conditions for NexoBrid® application, NexoBrid® application technique, and post-debridement wound care. Results In the first round, experts established consensus (strongly agree or agree) on 13 of the 38 statements. After the second round, a consensus was reached on 24 of the 25 remaining statements (97.2%). Conclusions The present updated consensus document provides recommendations on the use of bromelain-based enzymatic debridement NexoBrid®, integrating the extensive clinical experience of plastic surgeons, intensivists, and anesthesiologists in Spain. Further clinical trials and studies are required to corroborate, modify, or fine tune the current statements. Level of evidence: Not ratable

Bromelain‐based enzymatic burn debridement: A systematic review of clinical studies on patient safety, efficacy and long‐term outcomes

“…Although post‐BBD of deep burns often require more than 21 days to re‐epithelialize, long‐term cosmetic outcomes are equivalent, if not better, to surgical excision and grafting 54 . In cases of residual viable dermis that is insufficient to sustain spontaneous healing post‐BBD, prolonged pre‐ (2–24 h) and post‐ (12–24 h) NXB wet‐to‐dry soakings to ensure a moist environment, enhance graft take after a few days 39,41,43,53,55–60 . A moist wound environment is achieved with a plethora of dressings that have been used, including Suprathel®, Mepilex Ag®, Biobrane®, Medihoney® and allografts, 39,41,53 SpinCare™, an electrospun polymer nanofibrous temporary epidermal layer, 61 intact fish skin grafts (Kerecis®), 62 and Epiprotect™ (a thin film of biosynthetic cellulose polymer), 63 as well as platelet‐rich fibrin (PRF), 64 autologous cell therapy combined with PRF or fibrin glue 65 …”

“…54 In cases of residual viable dermis that is insufficient to sustain spontaneous healing post-BBD, prolonged pre-(2-24 h) and post-(12-24 h) NXB wet-to-dry soakings to ensure a moist environment, enhance graft take after a few days. 39,41,43,53,[55][56][57][58][59][60] A moist wound environment is achieved with a plethora of dressings that have been used, including Suprathel ® , Mepilex Ag ® , Biobrane ® , Medihoney ® and allografts, 39,41,53 SpinCare™, an electrospun polymer nanofibrous temporary epidermal layer, 61 intact fish skin grafts (Kerecis ® ), 62 and Epiprotect™ (a thin film of biosynthetic cellulose polymer), 63 as well as platelet-rich fibrin (PRF), 64 autologous cell therapy combined with PRF or fibrin glue. 65 After gaining ample experience with this novel product, 53,55,56 the post-BBD wound bed viability and perfusion are assessed immediately after removal of NXB, thus allowing surgeons to correctly diagnose wound depth, and potentially reduce the need for grafting (-Figure 2).…”

“…Since then, approximately 10 000 patients have been successfully treated with NXB for deep thermal burns. European consensus guidelines 39,40 and individual European country guidelines have been published, including Spain, 41,42 Italy, 43 Romania, 44 and Poland 45 . It is currently approved for use in forty‐four countries worldwide, most recently in the United States, 46 and in pre‐approval stages in Australia 47…”

Enzymatic Debridement of Deep Thermal Burns in the Russian Federation: First Experience

“…In recent years, due to the widespread introduction of minimally invasive technologies, surgical treatment of burns has given way to alternative and less aggressive interventions, in particular enzymatic debridement [ 17 , 18 , 22 , 23 ]. The method of enzymatic debridement using NexoBrid ® was studied elaborately for decades [ 24 ], and since 2012, after initially being approved for use in Europe [ 16 ], it has been gaining acceptance as standard practice in many countries around the world [ 17 , 18 , 25 , 26 , 27 , 28 , 29 ]. Early use of this bromelain-based gel has been reported to result in rapid, selective, efficient, and safe (compared to standard treatment methods) eschar removal without damaging the uninjured dermis.…”

Progress in Pluronic F127 Derivatives for Application in Wound Healing and Repair

“…It was loaded with bromelain and the epidermal growth factor stepwise to obtain hydrogels for wound cleansing and healing. 32 In this system, pineapple proteins were commonly employed in burn debridement 53 as the sulfhydryl groups in PVA-SH prevent their oxidation. By using the swelling test to evaluate its liquid absorption performance and moisturizing property, the hydrogel had the largest swelling ratio at 50 min.…”