Intracompartmental Pressure and Burn Depth Dynamics in Circumferential Deep Dermal Burns Treated with Bromelain-Based Enzymatic Debridement: A Retrospective, Hypothesis-Generating Single-Center Study.

Abstract

Background/Objectives: Circumferential deep dermal burns generate progressive sub-eschar pressure with risk of burn-induced compartment syndrome (BICS). Bromelain-based enzymatic debridement is a proposed non-surgical decompressive strategy, but the temporal kinetics of intracompartmental pressure (ICP) normalization and their relationship to burn depth are poorly characterized. We explored these kinetics and introduce, as an exploratory descriptive concept, the Enzymatic Decompression Half-Time (EDT₅₀), mapping the ICP normalization curve stratified by Laser Doppler Imaging (LDI) burn depth. Methods: In this single-center retrospective study, 31 adults with circumferential deep dermal burns (IIb, TBSA ≤ 20%) treated with NexoBrid^® were analyzed. ICP was measured at five time points (T0-T24 h) and LDI at T0 and T24 h. Subgroup analyses were treated as descriptive because several subgroups were small. Results: ICP declined progressively with no rebound (repeated-measures ANOVA, p < 0.001). EDT₅₀ appeared depth-dependent (high-flux 2.1 h; low-flux 5.9 h). No patient developed clinical BICS (0/31; 95% CI 0-11%). Pre-treatment LDI flux correlated negatively with ICP (r = -0.71) and EDT₅₀ (r = -0.64). Conclusions: In this small cohort, enzymatic debridement was associated with progressive ICP normalization without clinical compartment syndrome. These hypothesis-generating findings require prospective validation; established BICS remains an absolute indication for surgical escharotomy.