Dr Shane Jackson1, Dr Francesca Dudas1, Dr Andrea Issler-Fisher1
1Concord hospital, , Australia
Debridement of non-viable tissue (eschar) is the first step in the management of deep burn injuries. Over time new debridement techniques have been developed; from various instruments for sharp debridement, to hydrosurgery and autolytic dressings. However these methods have drawbacks, ranging from bleeding, to damage to surrounding tissues or delayed time to complete debridement.
Enzymatic eschar debridement is the latest development in this arena. NexoBrid® is a proteolytic protein derived from bromelain, found in pineapple stems, which selectively breaks down and removes eschar from deep dermal and full thickness burn wounds. It was developed in Israel in the 1990s and has been increasingly used in Europe over the past decade but has yet to gain widespread use elsewhere in the world.
We present our experience with the first use of NexoBrid® in Australia, including a case of a full-thickness electrical burn to the palm that fully healed without surgery, with full range of motion and no contracture. We will explore the benefits and pitfalls of enzymatic debridement in our cases, and discuss its potential role in the future of burn care.
Dr Shane Jackson is a plastic and reconstructive surgery registrar in Sydney, who has worked in each of the three NSW burn units