Objectives: The ideal debriding agent should be effective, fast, selective and non traumatic with minimal blood loss and maximal preservation of non-injured dermis that may heal spontaneously. Current surgical debridement is effective but traumatic and non-selective, and non-surgical methods are inefficiently slow. The use of NexoBrid (NXB), a concentrate of proteolytic enzymes enriched in Bromelain, is growing steadily in the EU and other areas. The objective of this work is to provide a comprehensive review of all clinical studies done with NXB.
Methods: Seven different clinical studies assessing the short and long term effects of NXB on deep burns were compiled. Of those, four were controlled (compared to the Standard of Care–SOC) and 2 were observer-blinded. The endpoints of debridement efficacy, time to complete debridement, surgical burden, and safety of a 4 hour application were studied in adults and children.
Results: Data from over 550 treated burn patients comparing NXB to SOC demonstrate that debridement in both arms was effective (> 90%). NXB removed the eschar earlier and faster, and the treated wound bed could be visually diagnosed and healed spontaneously (epithelialization) or by autografting. Overall surgical burden (expressed by need for excisional debridement, autografting and escharotomy) was significantly reduced, as was blood loss. The NXB effect on comprehensive burn care and time to wound closure changed according to the general post debridement strategy (surgical or non-surgical) applied. Long term results were at least as good as in SOC. Adverse events were consistent with those commonly seen in patients with deep burns.
Conclusions: NXB has been proven to be effective, fast acting and undamaging to uninjured tissues with the potential for increased chances for spontaneous epithelialization. An overall reduced surgical burden with favorable long term outcomes can be the basis for a minimally invasive approach to burn care.

Rapid enzymatic burn debridement: Review of seven clinical studies