Dr Daniel Isacson1, Associate Professor Fredrik Huss
1Uppsala University Hospital, Department of Plastic and Reconstructive Surgery, Uppsala, Sweden
NexoBrid, a bromelain-based enzymatic agent has in recent years become more prevalent in the treatment of burns. It is considered a safe debridement tool for the removal of eschar in adult patients without sacrificing viable healthy tissue. It may reduce surgical morbidity and blood loss, the need for skin grafting, infection rate, length of hospital stay and healthcare costs.
At Uppsala University Hospital burns center in Sweden, NexoBrid has been used for the past 5 years on a total of 29 patients. It has a short learning curve but its use becomes straight forward with appropriately trained staff.
In our experience we have found it a useful and safe alternative to patients not suitable or too unstable for surgery, and in difficult to treat areas such as hands. It is safe to use on smaller burns but should be avoided in large surface areas. The use of the agent is painful for patients and we only use it with sedation or regional blocks. With experience and training nurses can perform some of the steps without the presence of a surgeon. This allows nurses a sense of empowerment, as they become more involved in the treatment as well as the care of patients.
Daniel Isacson Md, PhD, is a fellow of the College of Swedish Plastic Surgeons. He works as a specialist in plastic and reconstructive surgery at Uppsala University hospital where one of the 2 tertiary referrals centers in Sweden is located. His main interests are reconstructive plastic surgery and burns. Currently he is employed as the plastic surgery fellow at Macquarie University Hospital.