Preliminary Single-Center Experience of Bromelain-Based Eschar Removal in Children with Mixed Deep Dermal and Full Thickness Burns

Abstract

Introduction: Early eschar removal is the standard management of burns. The goal is to remove all of the necrotic tissue and render the wound suitable for healing or skin grafting. The enzymatic debridement of burn wounds allows for minimally invasive removal of burn eschar. The aim of the study was to describe and compare the demographic characteristics, surgical treatment and outcomes of patients treated with Nexobrid® with patients who had standard surgical excision. Material and Methods: A retrospective review was conducted on children who underwent enzymatic debridement. The study group was compared with children treated with the standard of care (SoC). Results: Twelve children (mean age 8 years, range 3 to 15 years) with mixed deep dermal and full thickness burn wounds were treated with Nexobrid®. The mean size of the burns was 29% TBSA. The median percentage TBSA debrided using Nexobrid® was 15% (range 2–27%). In a clinical assessment, enzymatic debridement was effective in removing dead tissue in a single application. No adverse reaction to Nexobrid® and serious complications after enzymatic procedure were recorded in the study group. The estimated relative risk of the need for reconstructive procedures decreases 3.5 times for the study group (RR 3.5, 95%CI 0.9–13.5, p = 0.089). Conclusion: The bromelain-based enzymatic method offers a good and safe debridement option to improve the treatment and life quality of children with severe burns. The main outcome of interest was the number of reconstructive procedures due to scar contractures, which was reduced in the group treated enzymatically compared to the SoC-treated children.

Prevention and Treatment of Burn Scar Contracture: A Practical Review

“…Nexobrid (MediWound, Israel), an enzymatic debridement agent, was reported to decreased the need for scar contracture release when used in acute burns but is a novel method still in clinical studies. 97 Other additives and drugs currently in development have shown promising results. ( See table, Supplemental Digital Content 13, which displays a table summarizing studies which focused on drugs used to treat and prevent burn contractures and their outcomes, http://links.lww.com/PRSGO/C990.)…”

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

“…Ironically, these are the categories of patients in which the use of minimally invasive technologies is probably most justified. Despite the labeling restrictions, there are a significant number of publications on the use of NexoBrid ® in severely burned patients, including patients with burns over 60% TBSA, children, and other off-label categories of patients [ 18 , 30 , 47 , 48 , 49 , 50 ]. We believe these reports may reflect the additional potential benefits available with more widespread use of NexoBrid ® ; however, additional studies are needed to better assess these indications.…”

An Overview of Recent Developments in the Management of Burn Injuries

“…The bromelain-based enzyme cleanser Nexobrid ® , extracted from pineapple stems, is used for non-operative burn eschar removal [91]. The advantages and efficacy of this method are described in the papers by the Stru żyna research group [86,92,93], which are based on the experience of a burn treatment center in Poland and their comparisons with the outcomes of patients who underwent surgical excision. The authors of the study point out the selectivity in identifying burn areas and the possibility of avoiding secondary operations and reducing the number of reconstructive operations due to scar contractures.…”