Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Dermatol. May 2, 2017; 6(2): 32-41
Published online May 2, 2017. doi: 10.5314/wjd.v6.i2.32
Use of a selective enzymatic debridement agent (Nexobrid®) for wound management: Learning curve
Ricardo Palao, Jorge Aguilera-Sáez, Jordi Serracanta, Jose Manuel Collado, Bruce Patrik Dos Santos, Juan Pedro Barret
Ricardo Palao, Jorge Aguilera-Sáez, Jordi Serracanta, Jose Manuel Collado, Bruce Patrik Dos Santos, Juan Pedro Barret, Plastic, Reconstructive and Burns Unit Service, Vall d’Hebron University Hospital, 08035 Barcelona, Spain
Author contributions: Palao R, Aguilera-Sáez J and Serracanta J designed and performed research; Palao R, Aguilera-Sáez J, Serracanta J, Collado JM, Dos Santos BP and Barret JP analysed de data; Palao R, Aguilera-Sáez J and Dos Santos BP wrote the paper.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Vall d’hebron University Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors report no relevant conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Ricardo Palao, MD, Staff Member, Plastic, Reconstructive and Burns Unit Service, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain.
Telephone: +34-62-9330102
Received: August 23, 2016
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.

Keywords: Burns, Eschar, Debridement, Enzymatic debridement, Wound bed, Nexobrid®, Epithelialization, Dermis preservation, Autograft

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.