RAPID ENZYMATIC DEBRIDEMENT OF DEEP FACIAL BURNS IN
A PATIENT WITH SEVERE INHALATION INJURY: CASE REPORT
Ferančíková N., Šarkőzyová N., Koller J.
Objectives: To assess the off-label use of rapid enzymatic debridement of deep facial burns associated with severe inhalation injury.
Methods: A 53-year-old female patient sustained 16% TBSAB (Total Body Surface Area Burns) caused by fire to face, neck, trunk, both hands and right thigh associated with severe inhalation trauma. The burn depth was diagnosed clinically as mixed deep dermal/third degree of 12% TBSAB and superficial of 4% TBSAB. Enzymatic debridement of all the deep burn areas (8%TBSA), except the right thigh, was performed by bromelain derived proteolytic enzymes mixture gel (NexoBrid, MediWound). The procedure was accomplished according to manufacturer´s instructions. All the debrided wounds had been covered temporarily by freshfrozen porcine xenografts. Full thickness skin injury areas were closed by split thickness autografts, deep dermal areas were treated conservatively. 
Results: Single debridement efficacy was 95% on the face, neck and trunk and 90% on both hands. Healing by epithelization under xenografts of most of the wounds including face area was achieved within 5 weeks. Only 2,5% TBSA of the debrided areas on both hands and neck required autografts.
Conclusion: Deep facial burns are often combined with severe inhalation injury. The current method of choice for burn eschar removal is tangential excision. However, during tangential excision also viable tissues with good healing capacity are removed, which is important particularly in functional areas as are the face and hands. In our patient enzymatic debridement proved to be safe and effective on the face in a very high-risk patient with severe inhalation injury and unstable circulation as an alternative to tangential excision.

Rapid enzymatic debridement of deep facial burns in a patient with severe inhalation injury: Case report