Objectives
Surgical debridement of the burned hand may mean an important functional risk. Bromelain based enzymatic debridement has been reported to reduce the need for autografting as it leaves dermal remnants to allow sponataneous healing of partial thickness burns. This allows early rehabilitation which may have an important influence in eventual hand function. The aim of our study is to evaluate burn hand function after Nexobrid treatment and to compare it with healthy hand function.



Methods
Twelve prospective patients were evaluated during 2015 until March 2016 (4 females, 8 males), with an intermediate-deep burns in one of their hands. Burns were debrided using a bromelain based enzymatic product, without the need to be autografted during the follow up. Functional assessment were done using QuickDash test, Michigan Hand Outcomes Questionnaire and range of motion of the main hand joints. These tests were evaluated in the burned hand and in the healthy one.




Results
The average follow-up was 12 months, with an averaged QuickDash score in the burn hand was 2.15% with a range between 0% and 7.15%, while the non-burn hand score was 0% in all patients. Michigan Hand Outcomes Questionnaire media score was
98,1% in the burn hand, with a range betweeen 92.3% and 100%, in comparison with 99.43%, and 98,34% and 100%, in the non-burn hand. Either the Quick Dash or the MHOQ test scores reached the differences considered as Minimal Clinically important. Thumb opposition media range was 76% and 77.58% in the burn and healthy hand. Finally, proximal interphalangeal joint flexion range was 118.33% and 119.17% in the burn and healthy hand. None of these range differences were significant.





Conclusion
Bromelain based enzymatic debridement of intermediate burns in the hands with spontaneous healing allows an early functional recuperation, without differences with the healthy side in the questionnaires of functional assessment.

5 - Functional evaluation after enzymatic debridement of intermediate burns in hands