515 Enzymatic Debridement for Burns - Off Label Experience

The process of debridement involves the removal of devitalized tissue from a wound bed that aims to encourage granulation tissue to facilitate wound healing. Subsequently, there are differing methods of debridement that encompass mechanical, sharp and surgical debridement as well as autolytic, biological, enzymatic debridement. Debridement of burn eschar with the use of autografts is known to be the standard of care for the treatment of severe burns. However, the removal of eschar requires traumatic tangential excision that is non-selective and requires costly and extensive hospital resources. Selective enzymatic debridement is a technique that is commonly used in clinical practice. Bromelain based enzymatic debridement gels have shown to be an effective, safe and alternative method for selective debridement of burn eschar that reduces the need for surgical debridement with comparable results to usual care. In Israel, the use of enzymatic debridement for burns has been approved for use for more than 3 years. However, the use of enzymatic debridement has been for acute burns and applied no later than 48 hours after the burn injury. We report our experience with a series of cases involving a late presentation of a burn and one case of a necrotic wound in an autoimmune patient and a compromised patient who underwent a late enzymatic burn/wound debridement later than the recommended and commonly used product guidelines. In all cases, the use of Bromelain enzymatic debridement for burns and necrotic tissue post 48 hours was found to be effective with surgical debridement avoided. Although the application time was well beyond the recommended period, full debridement was achieved. Bromelain enzymatic debridement was found to be viable option for selective debridement of devitalised tissue even after the recommended and common practice guidelines. The use of enzymatic debridement in late burns transfers may be an effective method as a non-surgical selective enzymatic debridement agent. Additional studies are warranted to further investigate the viability of enzymatic debridement in late burn transfers.