title: Reepithelialization of mid-dermal porcine burns after rapid enzymatic debridement with Debrase®.
abstract: Reepithelialization of mid-dermal burns is delayed by the presence of a layer of necrotic eschar. The authors hypothesized that rapid selective debridement using an enzymatic bromelain-based preparation, Debrase®, would speed reepithelialization. Forty mid-dermal burns (2.5 × 2.5 cm) were created on the back and flanks of two anesthetized domestic pigs (25 kg) using an aluminum bar (150 g) preheated in hot water (80°C) and applied for 20 seconds. The burns were randomized to a 4-hour topical application of Debrase® (n = 20) or its vehicle (n = 20) followed by daily application of a petrolatum-based triple antibiotic. Wounds were visualized and photographed daily for evidence of reepithelialization. Reepithelialization was considered complete when the entire wound was opaque and dry when blotted with tissue paper. 4-mm full-thickness biopsies were obtained for histological analysis using hematoxylin and eosin staining by a board-certified dermatopathologist masked to the burn therapy at 7, 9, 11, and 13 days after injury. The primary outcome was time to complete reepithelialization of the burns. Secondary outcomes were the percentage of burns that were reepithelialized at days 7, 11, and 13 and the mean percentage reepithelialization on microscopic analysis. A sample of 20 burns in each group had 80% power to detect a 2-day difference in the time to complete reepithelialization (two-tailed, P < .05). Application of Debrase®, but not the control vehicle, resulted in dissolution of the necrotic upper dermis in all treated burns. The mean time to complete reepithelialization was faster for Debrase®-treated (7.4 ± 0.8 days) than control-treated (9.1 ± 2.1 days) burns: difference, 1.7 days (95% confidence interval, 0.5-2.9). The percentage of completely reepithelialized Debrase®- and control-treated burns were day 7, 65.0 vs 25.0% (P = .02); day 9, 80.0 vs 40.0% (P = .02); and day 11, 100.0 vs 92.0% (P = .45). Treatment of mid-dermal porcine burns with a single topical application of Debrase® results in earlier wound reepithelialization.
authors: Department of Emergency Medicine at Stony Brook University, Stony Brook, New York, USA.
authors: Adam J
authors: AJ
authors: Singer
authors: Breena R
authors: BR
authors: Taira
authors: Ryon
authors: R
authors: Anderson
authors: Steve A
authors: SA
authors: McClain
authors: Lior
authors: L
authors: Rosenberg
mesh_terms: D000287:Administration, Topical; D000818:Animals; D001963:Bromelains / Q000627:therapeutic use*; D002056:Burns / Q000473:pathology / Q000601:surgery*; D049109:Cell Proliferation; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D003646:Debridement / Q000379:methods*; D004195:Disease Models, Animal; D004848:Epithelium; D005260:Female; D010784:Photomicrography; D011446:Prospective Studies; D013223:Statistics as Topic; D013552:Swine; D013997:Time Factors; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D001963:Bromelains