Debridement of burn wounds can be achieved using both surgical and non-surgical methods. Enzymatic debridement is a form of non-surgical debridement; the most commonly described and clinically applicable form of enzymatic debridement is NexoBrid®.

NexoBrid® contains bromelain, derived from the stem of the Ananas comosus (pineapple), and consists of proteolytic enzymes. These enzymes are capable of debriding eschars without harming healthy tissue, thus selectively debriding the burned tissue and providing a healthy wound bed.

NexoBrid® is relatively expensive, limiting its use in low-resource settings, and training is required before this can be used in the setting of a clinic.

Indications

• Thermal burn wounds (flame, scald, contact)
• The treatment must start < 48 hours post burn injury
• For cases of burn-induced compartment syndrome (BICS) to prevent the need for escharotomies
• A maximum of 15% of TBSA can be treated per session; treatment can be performed on consecutive days, for example treating 15% TBSA on day 1 post-burn and treating the next 15% TBSA on day 2 post-burn

Debridement procedure

Training is required to use this technique in a clinic. The debridement procedure consists of three phases:

1. Pre-soaking phase (>2 hours). This stage has two aims: to prevent infection and to ‘soften’ the wound bed. The enzymes function better on moist, soft eschar, than on hard, dry eschar.
2. Treatment phase (4 hours).
3. Post-soaking phase (>2 hours). This stage uses the same methods as the pre-soaking phase, but in this phase the aim is to ‘dissolve’ the remaining eschar in the gauzes.

Post-treatment

Enzymatic debridement results in a healthy, debrided wound bed. It is imperative to preserve and protect this wound bed.

In the case of deep dermal partial thickness or full thickness burns, after debridement, decide whether to perform skin grafting or to await spontaneous re-epithelialization.