The standard of care for full thickness burns is surgical debridment followed by autografting. Recently the use of enzymatic debriding agent rich in bromelein has been proposed as a non surgical alternative for the removal of burn necrotic tissue. Local application of bromelain has been shown to be rapid, effective, non-invasive, safe, easily performed at the bedside with minimal blood loss. The activity on necrotic tissue seems to be mediated by a non-proteolytic component present in bromelain extract, named escharase.
In this paper it is described a clinical experience in the treatment of patients affected by extensive burns admitted to Turin Burn Center by means of an enzymatic debriding agent rich in bromelein. From January 2016 we treated 15 patients with acute burns, 10 male and 5 female, age ranging from 16 to 84 years. The percentage of the total body surface area ranged from 10% to 80%.  Treated surfaces ranged from 5 to 15% TBSA. All the treated burns were deep second and third degree . Anatomical involved regions were mainly located on the limbs. Concomitant trauma and previous diseases were registred. The treatment was applied in an early phase (1-8 days) following the producer recommendation. Debrided areas were immediately grafted with glycerol-preserved allografts or, in case of incomplete debridement, with topical preparations. In 8 cases patients were successively operated with autografts in the same areas; in the other cases a spontaneous healing was achieved.
The effectiveness of enzymatic debridement, prevalence of local infection and  healing time, as well as pathological scar occurrence and cosmetic results are discussed.

Enzymatic debridement by means of Bromelain in burns