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. 2025 Jun 12;6(2):36.
doi: 10.3390/ebj6020036.

Hand Function Recovers to Near Normal in Patients with Deep Dermal Hand Burns Treated with Enzymatic Debridement: A Prospective Cohort Study

Kelly Aranka Ayli Kwa  1   2 , Annika Catherina Reuvers  1   3 , Jorien Borst-van Breugel  1   4 , Anouk Pijpe  1   5   6 , Paul P M van Zuijlen  1   5   6   7   8 , Roelf S Breederveld  1   2 , Annebeth Meij-de Vries  1   8   9
Affiliations

Hand Function Recovers to Near Normal in Patients with Deep Dermal Hand Burns Treated with Enzymatic Debridement: A Prospective Cohort Study

Kelly Aranka Ayli Kwa et al. Eur Burn J. .

Abstract

Short- and long-term hand function was evaluated in adult patients with deep dermal and full-thickness hand burns after treatment with enzymatic debridement (NexoBrid® MediWound Ltd., Yavne, Israel), assessing the results at discharge and 3, 6, and 12 months post-burn. This prospective cohort study was performed in the Burn Center in Beverwijk between March 2017 and December 2019. Hand function was assessed using Modified Kapandji Index scores, the Jebsen-Taylor Hand Function Test, and range of motion; scar quality using the Patient and Observer Scar Assessment Scale version 2.0; and quality of life using the Quick Disability Arm Shoulder Hand Questionnaire and the Canadian Occupational Performance Measure. Ten patients (14 hand burns) were included. The need for a skin graft after NexoBrid® was 86%, and 50% needed additional surgical excision before skin grafting. Digits 3 and 4 achieved near-to-normal total active motion, and at least 50% of the hands achieved a normal range within the Jebsen-Taylor Hand Function Test in four items at 12 months post-burn. Scar quality and quality of life improved significantly over time. The present study can be considered as a proof-of-concept study for future clinical trials on enzymatic debridement for hand burns.

Keywords: burns; enzymatic debridement; hand function; quality of life; scar quality.

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Conflict of interest statement

Roelf S. Breederveld is the principal investigator at the local site (Red Cross Hospital, Beverwijk) that participated in the CIDS study (MW 2012-01-01), which is a multicenter, multinational, randomized, controlled, open-label study, performed in children with thermal burns to evaluate the efficacy and safety of NexoBrid compared to standard-of-care treatment. The CIDS study was initiated and is funded by Mediwound (Yavne, Israel), which is the manufacturer of NexoBrid. Kelly A. A. Kwa was a PhD candidate, not paid through the finances/grant received by Mediwound, who worked as a (local) researcher on the CIDS study. Prof. Paul P. M. van Zuijlen is the developer of the Patient and Observer Scar Assessment Scale.

Figures

Figure 1
Figure 1
Flowchart.
Figure 2
Figure 2
Evaluation of the hands after NexoBrid® treatment. (A) = flame burn; (B) = post-enzymatic debridement; (C) = 3 months post-burn; (D) = 6 months post-burn; (E) = 12 months post-burn.
Figure 3
Figure 3
Goniometry; median TAM over time. TAM = total active motion; 260° is considered normal. Friedman test, post hoc analysis, Wilcoxon signed-rank test, p < 0.0083. * Significant increase between the indicated months. ** Significant increase between every month, except between 3 and 6 months.
Figure 4
Figure 4
MKI scores and Q-DASH. MKI = Modified Kapandji Index. Q-DASH = Quick (shortened) Disability Arm Shoulder Hand Questionnaire. Friedman test, post hoc analysis, Wilcoxon signed-rank test. ● *compared to baseline; p < 0.0083. formula image ** significant for Q-DASH; p < 0.017.
Figure 5
Figure 5
POSAS scores over time. POSAS = Patient and Observer Scar Assessment Scale. Friedman test, * p < 0.05; post hoc analysis, Wilcoxon signed-rank test, p < 0.017, **** indicates statistical significance for all four items mentioned.
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