A Questionnaire-Based Study to Obtain a Consensus from 5 Polish Burns Centers on Eschar Removal by Bromelain-Based Enzymatic Debridement (Nexobrid®) in Burns Following the 2020 Updated European Consensus Guidelines

Korzeniowski, Tomasz; Strużyna, Jerzy; Chrapusta, Anna M; Krajewski, Andrzej; Kucharzewski, Marek; Piorun, Krzysztof; Nowakowski, Jakub; Surowiecka, Agnieszka; Kozicka, M; Torres, Kamil

doi:10.12659/msm.935632

Cited by 8 publications

(9 citation statements)

References 27 publications

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“…In recent years, due to the widespread introduction of minimally invasive technologies, surgical treatment of burns has given way to alternative and less aggressive interventions, in particular enzymatic debridement [ 17 , 18 , 22 , 23 ]. The method of enzymatic debridement using NexoBrid ® was studied elaborately for decades [ 24 ], and since 2012, after initially being approved for use in Europe [ 16 ], it has been gaining acceptance as standard practice in many countries around the world [ 17 , 18 , 25 , 26 , 27 , 28 , 29 ]. Early use of this bromelain-based gel has been reported to result in rapid, selective, efficient, and safe (compared to standard treatment methods) eschar removal without damaging the uninjured dermis.…”

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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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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“…Although, it is recommended to carry out enzymatic debridement in several stages, many of the centers in Europe had experience treating up to 25% TBSA in one session. The pretreatment risk stratification, adequate monitoring and hemodynamic support are needed when treating patients on more than 15% TBSA [ 15 , 16 , 17 ]. The literature lacks studies reporting the use of enzymatic debridement in children, with the exception of one manuscript presenting the combined experience in the use of Nexobrid ® in pediatric burns throughout three clinical trials, and the study that explores the different possibilities for pain management during enzymatic debridement in pediatric and adult burn patients [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Preliminary Single-Center Experience of Bromelain-Based Eschar Removal in Children with Mixed Deep Dermal and Full Thickness Burns

Korzeniowski

Grywalska

Strużyna

et al. 2022

JCM

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Introduction: Early eschar removal is the standard management of burns. The goal is to remove all of the necrotic tissue and render the wound suitable for healing or skin grafting. The enzymatic debridement of burn wounds allows for minimally invasive removal of burn eschar. The aim of the study was to describe and compare the demographic characteristics, surgical treatment and outcomes of patients treated with Nexobrid® with patients who had standard surgical excision. Material and Methods: A retrospective review was conducted on children who underwent enzymatic debridement. The study group was compared with children treated with the standard of care (SoC). Results: Twelve children (mean age 8 years, range 3 to 15 years) with mixed deep dermal and full thickness burn wounds were treated with Nexobrid®. The mean size of the burns was 29% TBSA. The median percentage TBSA debrided using Nexobrid® was 15% (range 2–27%). In a clinical assessment, enzymatic debridement was effective in removing dead tissue in a single application. No adverse reaction to Nexobrid® and serious complications after enzymatic procedure were recorded in the study group. The estimated relative risk of the need for reconstructive procedures decreases 3.5 times for the study group (RR 3.5, 95%CI 0.9–13.5, p = 0.089). Conclusion: The bromelain-based enzymatic method offers a good and safe debridement option to improve the treatment and life quality of children with severe burns. The main outcome of interest was the number of reconstructive procedures due to scar contractures, which was reduced in the group treated enzymatically compared to the SoC-treated children.

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“…ED is highly recommended in mixed mid-to-deep dermal or indeterminate burns to preserve as much viable dermis as possible for improved functional and esthetic outcome. Patients were treated following the protocol used in the Burn Center according to the manufacturer’s instructions and European consensus guidelines [ 21 – 23 ]. The entire procedure of ED was performed either under general anesthesia in the operation room/intensive care unit for severe burns when additional procedures were required or bedside in the burn ward by applying analgo-sedation protocol in spontaneously breathing patients.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of Bromelain-Based Enzymatic Debridement Combined with Laser Doppler Imaging and Healing of Burn Wounds

Korzeniowski¹,

Strużyna²,

Torres

2022

Med Sci Monit

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Background Accurate estimation of burn depth is crucial for correct treatment decision making. Bromelain-based enzymatic debridement (ED) may improve clinical assessment of burn depth. Laser Doppler imaging (LDI) provides a valuable indicator of burn depth by analyzing microcirculation within tissue beds. This study aimed to evaluate bromelain-based enzymatic debridement combined with laser Doppler imaging and healing of 42 wounds in 19 patients with mixed second- and third-degree thermal burns. Material/Methods We included 42 wounds in 19 patients with mixed deep dermal and full-thickness thermal burns. All patients were treated with eschar-specific removal agent for ED. The perfusion of each wound after ED was assessed using LDI. Healing time was estimated by 2 experienced burn surgeons and marked by the observation of epithelization. The usefulness of the LDI performed after ED in predicting healing time was estimated. The findings were analyzed to determine a cut-off value for LDI that indicates if a burn will heal spontaneously. Results We observed that burn wounds with higher mean perfusion healed faster. The analysis showed a strong relationship between perfusion after ED and healing time (Spearman rank correlation coefficient=−0.803). A mean perfusion greater than 296.89 indicated that the wound could heal spontaneously and does not require skin grafting. Conclusions LDI examination of an already debrided wound allows for a reliable assessment of perfusion at an early stage of treatment. The use of a safe and effective debridement method in conjunction with a non-invasive diagnostic tool could improve burn management.

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A Questionnaire-Based Study to Obtain a Consensus from 5 Polish Burns Centers on Eschar Removal by Bromelain-Based Enzymatic Debridement (Nexobrid®) in Burns Following the 2020 Updated European Consensus Guidelines

Cited by 8 publications

References 27 publications

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

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

Preliminary Single-Center Experience of Bromelain-Based Eschar Removal in Children with Mixed Deep Dermal and Full Thickness Burns

Evaluation of Bromelain-Based Enzymatic Debridement Combined with Laser Doppler Imaging and Healing of Burn Wounds

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