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Case Reports
. 2018 Dec 5:4:2059513118816534.
doi: 10.1177/2059513118816534. eCollection 2018 Jan-Dec.

Limitations to the use of bromelain-based enzymatic debridement (NexoBrid®) for treating diabetic foot burns: a case series of disappointing results

Juan Enrique Berner  1   2 , Dejan Keckes  1 , Matthew Pywell  1 , Baljit Dheansa  1
Affiliations
Case Reports

Limitations to the use of bromelain-based enzymatic debridement (NexoBrid®) for treating diabetic foot burns: a case series of disappointing results

Juan Enrique Berner et al. Scars Burn Heal. .

Abstract

Background: Bromelain-based enzymatic debridement with Nexobrid® (Mediwound) is an alternative to traditional surgical tangential excision of deep dermal and full thickness burns. Early literature suggests that Nexobrid debridement could reduce the number of operations, infection rates, inpatient stay and the necessity for skin grafting to wounds by preserving viable tissue. To our knowledge there are no previous studies reporting the use of NexoBrid for treating burns in patients with established diabetic foot disease.

Case presentation: We conducted a retrospective case series and identified four patients with diabetic foot burns that were treated with Nexobrid® debridement. All of these patients developed further eschar and deepening of their wounds a few days after NexoBrid was applied, requiring further surgery and skin grafting.

Conclusions: We would recommend judicious use of this new product in patients with diabetic foot wounds.

Keywords: Enzymatic debridement; NexoBrid; bromelain; burns; contact; diabetic; foot.

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Conflict of interest statement

Declaration of conflicting interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Case 1: Bilateral burns caused by prolonged contact with radiator.
Figure 2.
Figure 2.
Case 1: Bilateral burns caused by prolonged contact with radiator.
Figure 3.
Figure 3.
Case 1: Immediate post-NexoBrid photographs.
Figure 4.
Figure 4.
Case 1: Immediate post-NexoBrid photographs.
Figure 5.
Figure 5.
Case 1: State of wounds 72 h after NexoBrid debridement.
Figure 6.
Figure 6.
Case 1: State of wounds 72 h after NexoBrid debridement.
Figure 7.
Figure 7.
Case 1: Patient then required three further surgical debridements to obtain a wound bed suitable for grafting. This picture illustrates the state of his wound for his first graft check.
Figure 8.
Figure 8.
Case 2: Contact burn to right lateral foot from hot water bottle.
Figure 9.
Figure 9.
Case 2: State of wounds two days after bromelain-based enzymatic debridement.
Figure 10.
Figure 10.
Case 3: Contact burn to right sole from prolonged exposition to radiator.
Figure 11.
Figure 11.
Case 4: State of the wound three days after enzymatic debridement.
See this image and copyright information in PMC

References

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How to cite this article

    1. Berner JE, Keckes D, Pywell M, Dheansa B. Limitations to the use of bromelain-based enzymatic debridement (Nexobrid®) for treating diabetic foot burns: a case series of disappointing results. Scars, Burns & Healing, Volume 4, 2018. DOI: 10.1177/2059513118816534 - DOI - PMC - PubMed

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