Enzymatic debridement of deeply burned hand and the Debrase® based minimal invasive modality

Krieger, Yuval; Silberstein, Eldad; Gurfinkel, Reuven; Berezovski, A.; Sagi, Amiram; Rosenberg, L.A.

doi:10.1016/j.burns.2009.06.189

Cited by 6 publications

(9 citation statements)

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“…Additional studies to corroborate the findings of our work include Edmondson et al They strongly advocated for modern enzymatic approaches for eschar debridement which have the potential to maximize dermal preservation and improve long‐term scar outcomes 104 . Others considered debriding enzymes as adjuncts to surgical excision, and concluded that NXB is effective in deep burns by decreasing the percentage of grafting required without significant adverse effects 105–107 . Kwa et al found the TCD was the shortest for NXB, while the TWC was the longest compared to tangential excision, hydrosurgery, and shock waves, although this did not lead to decreased scar quality.…”

Section: Discussionsupporting

confidence: 74%

“…104 Others considered debriding enzymes as adjuncts to surgical excision, and concluded that NXB is effective in deep burns by decreasing the percentage of grafting required without significant adverse effects. [105][106][107] Kwa et al found the TCD was the shortest for NXB, while the TWC was the longest compared to tangential excision, hydrosurgery, and shock waves, although this did not lead to decreased scar quality. They hypothesized that this may be due to the earlier eschar removal and its implications on the quality of spontaneous healing.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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

Shoham

Gasteratos²,

Singer

et al. 2023

International Wound Journal

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In 2012 the European Medicines Agency approved a pineapple stem‐derived Bromelain‐based debridement concentrate of proteolytic enzymes (NexoBrid®, MediWound Ltd, Yavne, Israel) for adult deep burns. Over 10 000 patients have been successfully treated with NexoBrid® globally, including in the US. The aim of our study is to perform a systematic review of the current literature on Nexobrid® outcomes. We conducted a literature search in PubMed, Google Scholar, Embase, and other search engines (2013–2023). The online screening process was performed by two independent reviewers with the Covidence tool. The protocol was reported using the Preferred Reporting Items for Systematic Review and Meta‐Analyses, and it was registered at the International Prospective Register of Systematic Reviews of the National Institute for Health Research. We identified 103 relevant studies of which 34 were found eligible. The included studies report the positive effects of Nexobrid® on burn debridement, functional and cosmetic outcomes, scarring, and quality of life. Also, they validate the high patient satisfaction thanks to enhanced protocols of analgosedation and/or locoregional anaesthesia during Bromelain‐based debridement. Two studies investigate potential risks (coagulopathy, burn wound infection) which concluded there is no strong evidence of these adverse events. NexoBrid® is a safe, selective, non‐surgical eschar removal treatment modality. The benefits of Bromelain‐based debridement are faster debridement and healing times, reduced operations, length of stay, cases of sepsis, blood transfusions, and prevention of compartment syndrome. Existing evidence suggests that the indications and the role of Bromelain‐based debridement are expanding to cover “off‐label” cases with significant benefits to the global healthcare economy.

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Section: Discussionsupporting

confidence: 74%

Section: Strengths and Limitationsmentioning

confidence: 99%

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

Shoham

Gasteratos²,

Singer

et al. 2023

International Wound Journal

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“…The European consensus guidelines for enzymatic debridement of burn eschar provide a detailed overview of the implementation of bromelain use, a method that is already revolutionizing some aspects of hand burn care 40 . Seven articles assessed the role of enzymatic debridement in hand burns, and these tended to favor enzymatic debridement over other methods, as it tended to be initiated faster and led to more precise burn evaluation and more vital tissue preservation, with fewer procedures until debridement completion, and a marked reduction in the number of wounds requiring skin graft 122–126 . However, a comparison between surgical, enzymatic, and autolytic (hydrocolloid dressing) debridement for deep dermal burns where healing prediction was less than 3 weeks concluded that autolytic debridement using hydrocolloids was found to be the most effective technique with better scar outcomes, healing times, and functional recovery 10,11 .…”

Section: Resultsmentioning

confidence: 99%

Acute Management of Thermal Hand Burns in Adults

et al. 2021

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Introduction Advances in the evidence base of acute thermal hand burns help to guide the management of these common injuries. The aim of this literature review was to evaluate recent evidence in the field over 10 years. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols methodology was used as a guide for this literature review. PubMed, MEDLINE, EMBASE, CINAHL, and Google Scholar were searched for English language articles related to hand burns published between 2009 and 2018 inclusive, and the Cochrane Library was reviewed. Exclusion criteria were as follows: participants younger than 18 years, scar or contracture management, rehabilitation, outcomes assessment, late reconstruction, and electrical or chemical burns. Results An initial search retrieved 6493 articles, which was narrowed to 403 full-text articles that were reviewed independently by 3 of the authors and categorized. Of 202 included articles, there were 8 randomized controlled trials and 2 systematic reviews. Six evidence-based guidelines were reviewed. Referral of hand burns to specialist centers, use of telemedicine, early excision and grafting, and immediate static splintage have been recommended. Enzymatic debridement results in earlier intervention, more accurate burn assessment, preservation of vital tissue, and fewer skin grafts, and ideally requires regional anesthesia. Guidance on escharotomy emphasizes indication, technique and adequate intervention, and potential for enzymatic debridement. Inclusion of topical negative pressure, dermal regenerative templates, acellular dermal matrices, and noncellular skin substitutes in management has helped improve scar and functional outcomes. Discussion The results of this literature review demonstrate that multiple national and international societies have published burns guidelines during the decade studied, with aspects directly relevant to hand burns, including the International Society for Burn Injuries guidelines. There are opportunities for evidence-based quality improvement across the field of hand burns in many centers. Conclusions More than 200 articles globally in 10 years outline advances in the understanding of acute management of thermal hand burns. Incorporating the evidence base into practice may facilitate optimization of triage referral pathways and acute management for hand burns.

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“…This approach enhances the likelihood of spontaneous epithelialization, leading to improved aesthetic and functional outcomes. 7 , 23 , 24 …”

Section: Discussionmentioning

confidence: 99%

Enzymatic Debridement (Nexobrid) on Burned Hands: Retrospective Review from a Burn Referral Center in Spain

Lin Wu,

Bulla,

Aguirrezabala del Río

et al. 2024

Plastic and Reconstructive Surgery - Global Open

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Background: In deep burns, the gold standard of treatment is surgical debridement and coverage, but in hands, this may lead to poor aesthetic and functional results due to the complexity of this anatomical area. Enzymatic debridement (Nexobrid) allows for the preservation of the dermal remnant and reduces the number of skin grafts when compared with surgical excision. The study aimed to analyze the patients with intermediate second-degree or deeper burns in hands who required surgical treatment after Nexobrid and those who avoided it. Methods: A descriptive retrospective study of all patients who underwent Nexobrid following hand burns between May 2015 and April 2020 treated in Vall d’Hebrón University Hospital was conducted. After the enzymatic debridement, the burn unit team determined if the burn required conservative treatment or surgery, based on the characteristics of the wound bed. Results: A total of 202 hands were collected. Most hands included in this study had deep second-degree burns (122; 60.4%). Almost half of the hands underwent surgery (99; 49%), and most had deep second-degree burns (61; 61.62%). During follow-up, 24 hands required surgery for sequelae (11.88%) and 62 did not undergo follow-up (30.69%). In the group that needed sequelae surgery, 21 needed surgery after Nexobrid and three of them were healed with conservative treatment after Nexobrid (P < 0.001). Conclusions: Nexobrid decreases the number of surgical procedures in deep burns of the hand because more conservative attitudes are adopted. Also, it seems to reduce the need of surgery due to burn sequelae.

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Enzymatic debridement of deeply burned hand and the Debrase® based minimal invasive modality

Cited by 6 publications

References 0 publications

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

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

Acute Management of Thermal Hand Burns in Adults

Enzymatic Debridement (Nexobrid) on Burned Hands: Retrospective Review from a Burn Referral Center in Spain

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