State of the art in enzymatic debridement

Abstract

Surgical treatment of deep partial thickness to full thickness burn wounds by knife has been the undisputed standard of care and was one key point in surgical burn medicine for decades. Recently, it gets more and more challenged by Bromelain-based enzymatic burn wound debridement (ED) as technique for non-surgical, selective eschar removal. Although the literature on ED is increasing constantly it cannot comprise the rapid progress that is made in clinical application of ED. To outline the current state of art in ED, recent literature as well as clinical experience is summarized and the main steps in clinical application including indications, wound preparation, application of the enzyme, wound bed assessment and further treatment after ED are discussed. Initial indications and limitations in application of ED could be gradually extended to increase versatility of ED as tool in burn surgery. Several randomized controlled trials compared ED to standard of care (SOC). They could show significant shorter time to complete burn wound debridement and wound closure, reduced need for surgery, reduced blood loss, reduced area of burns that needed surgical excision and need for autograft as well as an improved scar quality. Further research is necessary to justify an extensive use of ED as tool for burn eschar removal. Especially a robust comparison to surgical burn wound excision by knife as SOC is required to facilitate evidence-based burn surgery.

Made in Germany: A Quality Indicator Not Only in the Automobile Industry But Also When It Comes to Skin Replacement: How an Automobile Textile Research Institute Developed a New Skin Substitute

“…in different publications [ 107 , 108 , 109 , 110 , 111 , 112 ]. Due to the increased effusion after E.D., a prolonged after soaking period of 5–8 h is indicated [ 112 ]. In a retrospective study assessing healing time after E.D., Suprathel ® showed a shorter healing time overall than polyurethane foam and cream application, especially in burns with a higher Baux Index, offering all the known advantages of Suprathel ® [ 113 , 114 ].…”

“…In the European consensus update, it was declared as appropriate, and in the Spanish consensus [107][108][109], it was declared as a most appropriate dressing material after E.D. in different publications [107][108][109][110][111][112]. Due to the increased effusion after E.D., a prolonged after soaking period of 5-8 h is indicated [112].…”

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

“…Most of the research focuses on Nexobrid ® application to smaller areas, with particular emphasis on debriding burned hands [ 28 , 29 , 30 , 31 ]. Considering the safety and selectivity of this method, its use in children and severe burns seems even more justified.…”

Porcine Xenograft and Epidermal Fully Synthetic Skin Substitutes in the Treatment of Partial-Thickness Burns: A Literature Review

“…These positive effects were explained with a new understanding of lactate’s role in energy distribution, utilization, and radical scavenging. The rate of hypertrophic scarring was not investigated in a direct comparison of PXs, and therefore only personal impressions about a better scar outcome in ST ® treated are reported [ 4 , 29 , 83 ].…”