Fast-track enzymatic debridement enables earlier eschar removal without compromising early outcomes in deep burns: A retrospective matched-pair analysis.

Abstract

Timely removal of burn eschar is a key determinant of infection control and subsequent wound management in deep burns. Enzymatic debridement using bromelain-based enzymatic debridement enables selective eschar removal; however, the commonly recommended prolonged pre-soaking may delay treatment. Evidence supporting the necessity of extended pre-soaking, particularly in clinically apparent full-thickness burns, remains limited. This single-center, retrospective matched-pair pilot study compared a fast-track enzymatic debridement protocol with short pre-soaking (<4 h) to a standard protocol with prolonged pre-soaking (≥4 h) in adult patients with deep burns. Seven matched patient pairs (n = 14) were analyzed, matched for age, burn size, depth, and anatomical site. The primary endpoint was timeliness of enzymatic debridement, defined as time from hospital admission to NexoBrid application. Secondary endpoints included debridement adequacy, subsequent wound management, and early safety outcomes. Time from hospital admission to enzymatic debridement was markedly shorter in the fast-track group. Time from injury to enzymatic debridement was also reduced (median 6 vs. 26 h). Adequate enzymatic debridement was achieved in all treated wounds in both groups. No wound infections or early safety signals attributable to the fast-track protocol were observed. Fast-track enzymatic debridement using bromelain-based enzymatic debridement, with a median initiation time of 2 h and without prolonged pre-soaking, enabled substantially earlier eschar removal without compromising early debridement adequacy or safety in this matched-pair pilot cohort. These findings support the feasibility of a pragmatic, workflow-oriented fast-track approach in selected deep burn wounds and warrant confirmation in prospective studies.