Dimitrie-Stefan Gologan

Background/Objectives: Bromelain-based enzymatic debridement (NexoBrid^®) is an established tissue-preserving alternative to tangential excision in deep partial-thickness burns. Its clinical efficacy is supported by randomised trials, but its systemic effects are inconsistently described and its effects at tissue level in humans are largely unknown. The objective was to synthesise the human evidence on both domains and to determine, as a prespecified endpoint, whether any study has evaluated them in the same patients. Methods: PubMed, Embase and Scopus were searched between 2016 and 2026 using two stream-specific strategies that shared their intervention and population blocks and differed only in their outcome block: Stream A, clinical outcomes reported with systemic biological parameters; Stream B, clinical outcomes reported with histopathological findings. Eligible studies were original human investigations published in the last ten years. Risk of bias was assessed with ROBINS-I and the JBI checklists, and the synthesis was narrative, following PRISMA 2020 and SWiM. Results: Of 559 records, twelve studies were included: ten in Stream A (970 patients) and two in Stream B (nine patients); no study identified by the present search met the criteria of both. C-reactive protein and procalcitonin were significantly higher after enzymatic than after surgical debridement throughout the first week, and, in the single study that analysed the treated area as a continuous exposure, the probability of a post-debridement coagulation alteration rose with the area treated (odds ratio 1.158 per percentage point of body surface). Early fever occurred in 14% of patients and predicted later wound infection. Both histological studies were purely qualitative: neither reported a thickness, a percentage or a cell count, and neither reported any laboratory value. Conclusions: Enzymatic debridement is associated with a measurable systemic response whose proposed mechanisms are all statements about tissue that has never been examined. The two literature fields describe the same process at two levels of observation, in different patients and at incompatible times. No validated instrument exists for quantifying the human burn biopsy after debridement.

Background/Objectives: Circumferential deep dermal burns generate progressive sub-eschar pressure with risk of burn-induced compartment syndrome (BICS). Bromelain-based enzymatic debridement is a proposed non-surgical decompressive strategy, but the temporal kinetics of intracompartmental pressure (ICP) normalization and their relationship to burn depth are poorly characterized. We explored these kinetics and introduce, as an exploratory descriptive concept, the Enzymatic Decompression Half-Time (EDT₅₀), mapping the ICP normalization curve stratified by Laser Doppler Imaging (LDI) burn depth. Methods: In this single-center retrospective study, 31 adults with circumferential deep dermal burns (IIb, TBSA ≤ 20%) treated with NexoBrid^® were analyzed. ICP was measured at five time points (T0–T24 h) and LDI at T0 and T24 h. Subgroup analyses were treated as descriptive because several subgroups were small. Results: ICP declined progressively with no rebound (repeated-measures ANOVA, p < 0.001). EDT₅₀ appeared depth-dependent (high-flux 2.1 h; low-flux 5.9 h). No patient developed clinical BICS (0/31; 95% CI 0–11%). Pre-treatment LDI flux correlated negatively with ICP (r = −0.71) and EDT₅₀ (r = −0.64). Conclusions: In this small cohort, enzymatic debridement was associated with progressive ICP normalization without clinical compartment syndrome. These hypothesis-generating findings require prospective validation; established BICS remains an absolute indication for surgical escharotomy.