Burn Debridment - Approach and Review

Abstract

Between January 2020 and December 2024, a significant number of burn patients were admitted to the Plastic Surgery Clinic of the Craiova Emergency Clinical Hospital. Due to the high incidence of burns requiring hospitalization and the limited number of beds available for such patients, it became essential to identify optimal treatment methods that could reduce hospital stay while ensuring favorable functional and aesthetic outcomes. Early debridement is considered a vital first step in the treatment of burn patients, ideally performed within the first few days post-injury. Burn treatment involves both surgical and systemic approaches. Surgical management includes debridement, skin grafting, and reconstruction. Tangential surgical debridement remains the gold standard for deep burns, allowing precise removal of necrotic tissue while preserving viable skin. However, it may be associated with disadvantages such as intraoperative blood loss and incomplete excision. Alternative methods have evolved, such as hydrodissection, which uses a high-pressure saline jet for selective debridement, particularly useful in partial thickness burns. Larval therapy (using sterile Lucilia sericata maggots) is another option, especially effective in infected or necrotic wounds, offering antimicrobial benefits as well. Enzymatic debridement, particularly with bromelain-based products, is a modern, selective, and less invasive method that promotes healing with minimal bleeding and often reduces the need for grafting. A clinical case from Craiova highlights the success of enzymatic debridement: a 75-year-old patient with extensive burns showed significant improvement and near-complete epithelialization after 24 days, without requiring grafts. These outcomes support the growing use of enzymatic agents as a valuable tool in modern burn management, offering rapid, effective treatment and better patient recovery.

Keywords: Enzymatic debridement; burn; hydrodissection; larval therapy.

Figure 1

Patient at admission

Figure 2

Appearance after enzymatic debridement

Figure 3

Dressings after enzymatic debridement

Figure 4

Appearance on 24th day after enzymatic debridement.

Figure 5

Management algorithm for enzymatic debridement in the burned patient