Bromelain-based enzymatic debridement as a treatment of choice in high-risk patient with deep facial burns, a case report

INTRODUCTION: Deep facial burns are often combined with inhalation injury that could lead to patient destabilization. Accurate timing of surgical debridement of deep burns in a critical patient is the real medical art. Especially in patients with deep burned face and hands, in whom early debridement promises better functional and aesthetic results. CASE PRESENTATION: A fifty-three-year-old woman sustained burns of 16% TBSA including face area. The treatment of the burn injury was complicated by severe inhalation trauma, which led to patient destabilization shortly after admission. Standard surgical debridement was risky at the time. We used a new enzymatic agent for early burn eschar necrolysis instead. All the debrided areas were temporarily covered with porcine xenografts. The facial burns healed spontaneously without the need for a skin transplant. Definitive surgery treatment of full-thickness burns was postponed until the patient´s stabilization. DISCUSSION: The new enzymatic debridement is minimally invasive and can be applied bedside without the need for general anesthesia. All advantages of the new enzymatic debridement had led to extend its use at the face area, although it was not tested in this area during pre-registration studies. Especially in facial area high selectivity and significant reduction of skin grafting expect a better aesthetic and functional outcome. CONCLUSION: Bromelain-based enzymatic debridement proved to be safe and effective on the face in a very high-risk patient with unstable circulation and severe inhalation injury as an alternative to tangential excision.