Use of a selective enzymatic debridement agent (Nexobrid<sup>®</sup>) for wound management: Learning curve

Palao, R.; Aguilera-Sáez, Jorge; Serracanta, Jordi Franch; Collado, Jose Manuel; Santos, Bruce Patrik Dos; Barret, Juan P.

doi:10.5314/wjd.v6.i2.32

Cited by 11 publications

(12 citation statements)

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“…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 …”

Section: Discussionmentioning

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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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: Discussionmentioning

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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“…We believe that the three patients who achieved only partial eschar removal (70–80%) were the result of a technical issue where the contact between the NexoBrid ® and the wound bed was incomplete due to uneven anatomical surfaces. There is a learning curve associated with the use of NexoBrid ® , and we believe learning to overcome such issues is part of it [ 32 , 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…There are published positive healing results with a wide array of post-NexoBrid ® dressings, e.g., Suprathel, Biobrane, saline soaks, and silver sulfadiazine [ 18 , 32 , 34 , 37 , 38 , 39 ]. However, as of today, no single agent has been shown to be superior to others for treating the post-enzymatic debridement wound bed.…”

Section: Discussionmentioning

confidence: 99%

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

Алексеев

Malyutina

Bobrovnikov

et al. 2023

Life

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Since its approval in Europe a decade ago, NexoBrid® enzymatic debridement of deep thermal burns has been gaining acceptance as standard practice around the world. The purpose of this study is to report the first experience with NexoBrid® in the Russian Federation. During 2019–2020, we conducted a post-registration clinical study assessing the safety and treatment results of NexoBrid® enzymatic debridement. The study involved 15 adult patients suffering from deep thermal burns over an area ≤15% of their total body surface area. Patients were treated with NexoBrid® within 3 days of injury, followed by spontaneous or surgical wound closure. Complete eschar removal was achieved in twelve patients, 80% eschar removal in two patients, and 70% in one patient. Complete spontaneous epithelialization of wounds was achieved in 12 patients (80%) within 18 ± 1.9 days after the start of treatment. We did not witness pathological scarring during follow-up, and there were no significant safety issues throughout the study. Early use of NexoBrid® resulted in rapid, effective, and safe eschar removal with good results and sufficient preservation of viable dermis to allow for spontaneous healing in 80% of patients. These results demonstrate the ability to minimize surgical intervention and hopefully lead to better long-term scarring results.

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“…The visual assessment of wound bed characteristics at this point after completion of enzymatic debridement is crucial for determination of further therapy and, thus, requires special diligence, experience, and documentation. Clinical characteristics such as visible tissues, structures, or bleeding patterns allow for the accurate estimation of burn depth after ED [76]. Similar to classic treatment algorithms, after ED, deeper burns-indicated by persistent paleness and sporadic, large diameter bleedings-should also be followed by skin grafting, whereas more superficial burn patterns-indicated by a pink wound bed or numerous disseminated pinpoint lesions-can undergo a conservative treatment pathway [65].…”

Section: Discussionmentioning

confidence: 99%

Role, Development, and Value of Enzymatic Debridement as Integral Component in Initial Treatment of Burn Injuries Exemplified by NexoBrid®

Mattern

Fuchs

Schiefer

2022

EBJ

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Despite intensive research and increased knowledge over the past decades, the handling of severe burn injuries remains complex and is mainly based on clinical experience. High demands in terms of the diagnosis and choice of therapy often confront clinicians with challenging circumstances. Thus, the treatment of burn injuries has predominantly remained under the responsibility of specialised centres. As a new approach in addition to conventional surgery, enzymatically controlled debridement has come into focus for the treatment of burn injuries over the past years. The efficacy and safety of enzymatic debridement has already been implemented by numerous reputable studies. Promising results from the literature are enhanced by feedback from various conference contributions, intradisciplinary exchanges, and international collaborations. The implementation of enzymatic debridement in initial care management was found to be capable of reforming Standards of Care in numerous burn centres by facilitating treatment determinations and reducing the number of classical surgical interventions. Nevertheless, its use is also subject to certain restrictions as usage has shown limitations concerning efficacy when applied to scalds or pre-treated wounds. Enzymatic debridement shows high efficacy in terms of tissue debridement by combining this feature with the minimisation of collateral damage and a broad field of application in burn injuries. Due to their impressive performance in the treatment of burn injuries, enzyme-based techniques have also attracted attention for the treatment of other pathologies such as chronic wounds and are objects of ongoing research in this field. In this article, we illustrate the significance of enzyme-based treatment in initial burn care and shed some light on the potential value of enzymatic approaches in future burn surgery.

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Use of a selective enzymatic debridement agent (Nexobrid^®) for wound management: Learning curve

Cited by 11 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

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

Role, Development, and Value of Enzymatic Debridement as Integral Component in Initial Treatment of Burn Injuries Exemplified by NexoBrid®

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Use of a selective enzymatic debridement agent (Nexobrid®) for wound management: Learning curve

Cited by 11 publications

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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

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

Role, Development, and Value of Enzymatic Debridement as Integral Component in Initial Treatment of Burn Injuries Exemplified by NexoBrid®

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Use of a selective enzymatic debridement agent (Nexobrid^®) for wound management: Learning curve