State of the art in enzymatic debridement

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Surgical treatment of deep partial thickness to full thickness b wounds by knife has been the undisputed standard of care and was one key point in surgical b medicine for decades. Recently, it gets more and more challenged by Bromelain-based enzymatic b wound debridement (ED) as technique for non-surgical, selective eschar removal. Although the literature on ED is increasing constantly it cannot comprise the rapid progress that is made in clinical application of ED. To outline the current state of art in ED, recent literature as well as clinical experience is summarized and the main steps in clinical application including indications, wound preparation, application of the enzyme, wound bed assessment and further treatment after ED are discussed. Initial indications and limitations in application of ED could be gradually extended to increase versatility of ED as tool in b surgery. Several randomized controlled trials compared ED to standard of care (SOC). They could show significant shorter time to complete b wound debridement and wound closure, reduced need for surgery, reduced blood loss, reduced area of bs that needed surgical excision and need for autograft as well as an improved scar quality. Further research is necessary to justify an extensive use of ED as tool for b eschar removal. Especially a robust comparison to surgical b wound excision by knife as SOC is required to facilitate evidence-based b surgery.
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