Early
debridement and/or eschar removal is regarded as a significant step in the treatment of deep partial and full thickness
burns. It aims to control
wound bioburden and allows early
wound closure by
conservative treatment or
skin grafting. Preservation of viable dermis accompanied by early
wound closure, is regarded as a necessary step to reduce
scar related complication, e.g. functional limitations and/or unaesthetic
scar formation. Aside from the classical techniques of surgical excision as tangential excision for eschar removal, hydro-surgery,
maggot therapy,
laser, enzymatic
debridement have been described as additional techniques in the
burn surgeon's armamentarium. It is widely accepted that early eschar removal within 72h improves the outcome of
burn wound treatment by reducing bacterial
wound colonization,
infection and length of
hospital stay. In contrast, the right technique for eschar removal is still a matter of debate. There is increasing evidence that enzymatic
debridement is a powerful tool to remove eschar in
burn wounds, reducing blood loss, the need for autologous
skin grafting and the number of
wounds requiring surgical excision. In order to assess the role and clinical advantages of enzymatic
debridement by a mixture of
proteolytic enzymes enriched in
Bromelain (Nexobrid®) beyond the scope of the literature and in view of users' experience, a European Consensus Meeting was scheduled. The aim was to provide statements for application, based on the mutual experience of applying enzymatic
debridement in more than 500 adult and pediatric patients by the consensus panelists. Issues to be addressed were: indications,
pain management and
anesthesia, timing of application, technique of application, after-intervention
care, skin grafting after enzymatic
debridement, blood loss, training strategies and learning curve and areas of future research needs. Sixty-eight (68) consensus statements were provided for the use of enzymatic
debridement. The degree of consensus was remarkably high, with a unanimous consensus in 88.2% of statements, and lowest degree of consensus of 70% in only 3 statements. This consensus document may serve as preliminary guideline for the use of enzymatic
debridement with user-oriented recommendations until further evidence and systematic guidelines are available.