Peer-review started: August 24, 2016
First decision: October 8, 2016
Revised: November 16, 2016
Accepted: January 20, 2017
Article in press: January 21, 2017
Published online: May 2, 2017
To evaluate the efficacy of Nexobrid® in the initial management of burns and lessons learned with the procedure.
From January 27th 2015 until January 25th 2016, 25 patients aged between 18-94 years old with deep partial and full thickness burns were treated with Nexobrid® covering 1%-30% of their total body surface area (TBSA). The debridement was applied in the first 96 h post-injury following the protocol suggested for Nexobrid®. In patients with burns of more than 15% TBSA a second application of Nexobrid® was performed. After the removal of the product - 4 h post application and after a 2 h period of wet dressing - we used several products to cover the wound like Suprathel®, Biobrane®, Mepitel® with wet dressing, silver sulphadiazine 1% cream, and in some cases even autografts. We treated patients with inhalation injury as well. All the procedures were done under deep sedation, regional blocks in extremities or general anaesthesia in the intensive care unit room or in the operating theatre.
After these first 25 cases, we have observed that patients with partial thickness burns treated with Nexobrid®, experienced great benefits in the reduction of the need for autografting compared with the standard of care. This is because after selective enzymatic debriding of the burn scar we can distinguish different wound beds, which can coexist in the same patient, and we also managed to associate each one to its ability to epithelize. In major burns, besides the improvement in wound healing, we observed an important improvement in their general state. This may be because SIRS significantly improved through a bloodless debridement of necrotic tissue, decreasing the requirements of vasoactive drugs and fluid resuscitation. Circumferential burns also benefited from enzymatic debridement, observing a decrease in the number of compartment syndromes and the need for escharotomies. At present, we have not observed a positive effect in the evolution and outcome of major burns with inhalation injury.
The introduction of Nexobrid® shows significant improvement in burn treatment. Cumulative experiences are necessary to adapt its application in all Burns Centres.
Core tip: Burns continue to be a common injury in western countries. It is difficult to assess the severity of burns, but knowing its mechanisms as well as its characteristics can be of help. An alternative to surgical debridement is the enzymatic or chemical debridement, although past reports that used it with patients show that its efficiency is limited. Nexobrid® is a new enzymatic debridement agent. We show our learning curve with it.