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A retrospective review of an off-label bromelain-based selective enzymatic debridement (Nexobrid®) in the treatment of deep, partial, and full thickness burns and hard to heal wounds

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Harats, M, Haik, J, Cleary, M ORCID: 0000-0002-1453-4850, Vashurin, I, Aviv, U and Kornhaber, R ORCID: 0000-0001-6556-6775 2020 , 'A retrospective review of an off-label bromelain-based selective enzymatic debridement (Nexobrid®) in the treatment of deep, partial, and full thickness burns and hard to heal wounds' , IMAJ, vol. 22, no. 2 , pp. 83-88 .

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Abstract

Background: Rapid and selective bromelain-based enzymatic debridement provides a non-surgical alternative for the eschar removal in deep burns, which allows for early debridement of large surface areas, accurate evaluation of burn and wound depth, and the need for skin grafting.Objectives: To evaluate the efficacy of application of a bromelain-based selective enzymatic debridement (Nexobrid®) beyond the manufacturer's guidelines for use in burns > 48 hours as well as chemical, electrical, and pediatric burns, and chronic wounds.Methods: This retrospective review included records collected between January 2017 and April 2019, from male and female patients aged 8 months to 99 years with deep burns or wounds treated with bromelain-based selective enzymatic debridement.Results: Of the 33 patients who received the bromelain-based selective enzymatic debridement agent beyond the manufacturer's guidelines, 25 (76%) were observed to have successful debridement of the eschar, 8 (24%) were observed to have little effect on the burn eschar. Sixteen required further surgery after debridement. Clinical data on the use of bromelain-based selective enzymatic debridement agents are limited, but these results suggest the capacity to effectively debride burns > 48 hours (late presentation burns), use for pediatrics and for chemical and electrical burns, and apply to hard to heal full thickness chronic wounds.Conclusions: Bromelain-based selective enzymatic debridement was found to be an effective treatment modality beyond the recommended guidelines including late presentation burns and chronic wounds. This debridement method warrants further consideration when making clinical decisions concerning burn and wound care.

Item Type: Article
Authors/Creators:Harats, M and Haik, J and Cleary, M and Vashurin, I and Aviv, U and Kornhaber, R
Keywords: wound management, bromelain-based enzymatic debridement, burns, eschar, excision, wounds
Journal or Publication Title: IMAJ
Publisher: Israel Medical Assoc Journal
ISSN: 1565-1088
Copyright Information:

Copyright 2020 Israel Medical Association

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