[Burn wound treatment through enzymatic debridement: First experience in Switzerland]

Thermal injuries are frequent and can be associated with relevant morbidity and mortality in severe cases. Excisional debridement followed by autografting is the standard of care for deep burns, but is associated with serious potential complications. Clinical results of a novel enzymatic debridement based on Bromelain raw material extracted from the pineapple plant (Nexobrid™) were published in 2014. At the Center for Burns at the University Hospital Zürich enzymatic debridement was introduced in 2016. Our experience and interpretation of the first 12 cases are reported.

Patients of at least 18 years of age with second and third degree burns were included in this study. Pregnant or breast feeding women were excluded. After so-called "pre-soaking" with saline solution, the Nexobrid™ gel was applied for 4 hours with occlusive sealing. After abrasion of the debris, "post-soaking" with Prontosan^® followed and definite wound dressings were applied.

The mean age of the patients was 51 (19-78) years, the length of hospital stay was 38 (1-92) days. The amount of burns was 25 (1-67) % of the total body surface area (TBSA). On average, 11 (1-18) % of the TBSA was debrided with Nexobrid™ after 7 (1-19) days. In 8 patients, the defects completely healed without scarring after Nexobrid™ treatment. In 4 patients additional surgical measures were necessary to complete the debridement as well as to cover the defect. The treatment with Nexobrid™ was efficient in difficult treatment areas such as back, hands and feet, where preservation of the demis prevented joint contracture through scarring.

Treatment with Nexobrid™ extends the armamentarium to treat partial second-degree thermal injuries with good long-term results. It can be applied in analgosedation in an intensive care setting and reduces the need for surgical treatment.