The enzymatic debridement for the treatment of burns of in-determinate depth.

The rapid eschar removal by surgical debridement is currently considered the standard of care for the treatment of burned patients. However, the excision of viable dermal residues can frequently occurs when this procedure is applied affecting, in turn, the possible spontaneous re-epithelialization of the lesion area and increasing the amount of autologous skin grafts required for its treatment. To overcome these problems, the use of enzymatic debridement by proteolytic enzymes enriched in Bromelain has aroused great interest in the clinical field as a valid alternative to surgical procedure for the treatment of burns when they appear of in-determinate depth. With the aim to evaluate the effectiveness of this new approach in comparison with surgical procedure for the treatment of these type of burns we performed a retrospective data analysis taking into account patients hospitalized in our Burns Center from 2014 to 2017. The results obtained show a significant reduction in the time frame to perform debridement when enzymatic approach is chosen, with the maintenance of viable dermal tissue on the superficial areas of the wounds, their spontaneous re-epithelialization and a reduction of the bleeding in the treated patients. A reduced amount of autologous skin grafts is also used when enzymatic treatment is applied. The length of stay of the patients treated with enzymatic debridement did not show significant differences compared to that treated with surgery, with excellent aesthetic results after 1-3 years.