Single center experience of the first 300 patients treated with bromelain-based enzymatic debridement

Background

This retrospective cohort study evaluates the clinical outcomes of enzymatic debridement (ED) with Nexobrid® in burn patients treated at our hospital’s Burn Unit from 2015 to 2020. The primary aim was to determine whether Nexobrid® effectively reduces unnecessary surgeries and improves patient outcomes.

Methods

The study included 300 patients over 18 years old with deep dermal and full-thickness burns, excluding cases with chemical/electrical burns, pregnancy, and allergies to Nexobrid®. Burn depth was assessed upon admission and re-evaluated post-ED. The primary endpoint was the reliability of ED in determining surgical indications compared to traditional clinical assessments. Secondary endpoints included factors influencing healing time, complication rates, and scar hypertrophy.

Results

Among the 300 patients (76 % male, median age 41), flame burns were most common (46.7 %). Median total body surface area (TBSA) burned was 8 %, and TBSA treated with Nexobrid® was 5 %. Sequential ED was performed in 26 patients with larger burns.

Post-treatment data indicated that ED improved burn depth diagnosis compared to initial assessments, often downstaging dermal burns. The “step sign” emerged as a useful predictor for graft surgery necessity in dermal burns. No significant differences were observed between scald and flame burns in ED effectiveness. ED was associated with blood loss, emphasizing caution in cases with high TBSA, and early fever was noted as a factor requiring vigilant monitoring. While scar hypertrophy was associated with surgery, this study design could not directly evaluate ED's impact on hypertrophy.

Conclusion

We found ED to be a reliable method for rapid eschar removal and accurate burn depth evaluation, which often helped us avoid unnecessary surgeries—particularly important in delicate, functional areas like the upper limbs. Interestingly, the effectiveness of ED was not influenced by the burn’s etiology when treating intermediate-depth injuries. While ED does not appear to rise the risk of infection, early fever should still be carefully monitored. Over time, ED has become a central tool in our burn treatment protocols. Future studies are needed to explore its impact on treating patients with extensive burns.