Objectives:
To compare the efficacy of the bromelain-based enzymatic debridement (Nexobrid) before and after the removal of persistent dry eschar by surgical debridement based on a case treated in our center.
To analyze the indications of the manufacturer of the product and the current literature about the adequate aproach to persistent dry eschar in thermal burns before application of the bromelain-based enzymatic debridement (Nexobrid).
Methods:
A bibliographic search was carried out in the Pubmed search engine for the terms "enzymatic debridement" and "Nexobrid", selecting the articles related to the subject of this work by reading the abstract.
The manufacturer’s guidelines of the bromelain-based enzymatic debridement (Nexobrid) was reviewed.
The clinical history of a patient with a thermal burn who was admitted to our center was reviewed. The patient presented a full dermal thickness burn with dry eschar on its surface. Due to the depth of the burn, it was decided to perform enzymatic debridement with Nexobrid. This dry eschar limited the effect of the enzymatic debridement. After the poor result, we decided to perform a bedside escharectomy by surgical debridement to perform later a new application of Nexobrid.

Results:
The second application of the enzymatic debriding agent based on bromelain (Nexobrid) after surgical exeresis of the dry eschar achieved satisfactory debridement, removing all the devitalized tissue and respecting the healthy dermis. No adverse effect attributable to the second application of Nexobrid was detected. Seven days later a partial skin graft was performed. This graft evolved favorably and complete re-epithelialization of the area was achieved 3 weeks later.

Conclusion:
This case demonstrates that in cases of thermal burns with dry eschar at the time of application of the bromelain-based enzymatic debridement (Nexobrid), the efficacy of the product may be limited. In these cases, it seems necessary to remove previously the dry eschar to subsequently apply the product. Furthermore, performing a second enzymatic debridement with Nexobrid in the same area seems to be safe. However, more evidence is needed to prove it.

Objectives:
- To compare the efficacy of the bromelain-based enzymatic debridement (Nexobrid) before and after the removal of persistent dry eschar by surgical debridement based on a case treated in our center.
- To analyze the indications of the manufacturer of the product and the current literature about the adequate aproach to persistent dry eschar in thermal burns before application of the bromelain-based enzymatic debridement (Nexobrid).

Methods:
- A bibliographic search was carried out in the Pubmed search engine for the terms "enzymatic debridement" and "Nexobrid", selecting the articles related to the subject of this work by reading the abstract.
- The manufacturer’s guidelines of the bromelain-based enzymatic debridement (Nexobrid) was reviewed.
- The clinical history of a patient with a thermal burn who was admitted to our center was reviewed. The patient presented a full dermal thickness burn with dry eschar on its surface. Due to the depth of the burn, it was decided to perform enzymatic debridement with Nexobrid. This dry eschar limited the effect of the enzymatic debridement. After the poor result, we decided to perform a bedside escharectomy by surgical debridement to perform later a new application of Nexobrid.


Results:
The second application of the enzymatic debriding agent based on bromelain (Nexobrid) after surgical exeresis of the dry eschar achieved satisfactory debridement, removing all the devitalized tissue and respecting the healthy dermis. No adverse effect attributable to the second application of Nexobrid was detected. Seven days later a partial skin graft was performed. This graft evolved favorably and complete re-epithelialization of the area was achieved 3 weeks later.

Conclusion:
This case demonstrates that in cases of thermal burns with dry eschar at the time of application of the bromelain-based enzymatic debridement (Nexobrid), the efficacy of the product may be limited. In these cases, it seems necessary to remove previously the dry eschar to subsequently apply the product. Furthermore, performing a second enzymatic debridement with Nexobrid in the same area seems to be safe. However, more evidence is needed to prove it.

P.043 Multiple application of bromelain based enzymatic debridement (Nexobrid®) combined with tangential debridement for eschar removal in deep thermal burns

Dear friends and colleagues,

We will be pleased to welcome you in Turin (Italy) for the 19th European Burns Association´s Congress in 2022. Italy is honored to hold the meeting of the European Burns Association for the second time, after Verona in 1995. Turin is easily reachable from everywhere in Europe, either travelling by car, train or choosing flight connections. During the meeting, held in the renewed industrial center of the main Italian historical automotive factory (i.e. Lingotto-FIAT), we will meet international burn specialists, focusing on standards of care, progresses in burn treatment, strategies to face disaster situations, with a special attention to education of younger colleagues. However, in your spare time, you might enjoy the sweet days of Italian late summer, simply wandering in the green parks and gardens along the two rivers which cross the city, or you might decide to discover the numerous art galleries, churches, palaces, libraries, walking across elegant squares and large boulevards, passing through centuries of art and history; finally, you may choose to immerse yourself in some of the most exciting museum experiences, such as the Cinema Museum and the Turin’s Egyptian museum.

Looking forward to seeing you all in Turin for the 19th European Association´s Congress in 2022!
Maurizio Stella, Congress President, Turin Burn Centre