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

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.