Objectives
Modern era of treatment of burn injury stated with revolutionary approach of early surgical debridement followed by autologous skin grafting since early sixties of the last century. For many decades it’s been a gold standard treatment. It’ s considered effective although not selective approach in terms of blood loss and vital tissue preservation.
We hypothesized that selective enzymatic debridement could have the positive outcome in terms of local control of wound healing and could decrease systemic inflammatory response.


Methods
Since February 2017 till February 2019 in our Burn Unit, we treated over 50 cases of partially deep and deep burns. Thirty nine out of 50 was >15% TBSA ( 15 - 85%). Most of the patients (34 out of 39) was treated in BU or ICU. According to our protocol allograft skin grafting followed enzymatic debridement. Skin biopsy was performed before and after treatment. Three cases died for other complications and comorbidity.


Results
We respected the gold standard performing complete selective debridement within 1,4 days .Mean age was 54,1ys ( 1.1-96 ys). No blood transfusion was necessary after enzymatic debridement. Only one procedure was necessary for the majority patients ( 32 out of 39 pt). Twenty eight out of 39 patients went to OR for skin grafting. For the burn wound completion there was a necessity of average 5,8% autografts. Infection was well controlled with antibiotics therapy. Five cases of sepsis and one case of bacteremia was registered.


Conclusion
Regardless it a limited number of patient and only one year of experience, obtained results are encouraging. Rapid enzymatic debridement as a minimally invasive tool permitted to control burn wound not only on the local level but it seam like that has improved pro and anti-inflammatory response in terms of better control of the SIRS. Further investigations will be necessary to confirm it.

4 - The use of enzymatic debridement in large burns two years of experience