title: Enzymatic debridement of deeply burned faces: Healing and early scarring based on tissue preservation compared to traditional surgical debridement.
abstract: BACKGROUND
  Facial burns occur frequently and depending on the injured skin layers often heal with scars which may cause permanent functional and cosmetic sequelae. Preservation of the sensitive facial skin layers, especially of the dermis is essential for scarless epithelialisation. Enzymatic debridement of deep thermal burns has already been shown to assist with preserving viable dermis. However, up to date, there are no published reports on wound healing and in the long term aesthetic outcome after enzymatic debridement of facial burns.
  
  
  METHODS
  Therefore we performed a-single centre clinical trial that included 26 subjects aged 18-78 years with facial burns clinically evaluated as deep dermal or deeper. Burns were treated either with enzymatic debridement or excisional surgical debridement. Then we compared both groups regarding debridement selectivity, wound closure and scar quality after more than 12 months.
  
  
  RESULTS
  Enzymatic debridement significantly reduced time to complete wound closure after admission (19.85 days versus 42.23 days, p=0.002), and after enzymatic eschar removal (18.92 days versus 35.62 days, p=0.042). The number of procedures to complete debridement were significantly lower in the enzymatic debridement group (1.00 versus 1.77, p=0.003). 77% of facial burns that had been debrided enzymatically were found to be more superficially burned than initially estimated. Wounds undergoing autografting of any size were significantly reduced by enzymatic debridement (15% versus 77%, p=0.002). Scar quality after enzymatic debridement was superior compared to surgical debridement after 12 months regarding pigmentation (p=0.016), thickness (p=0.16), relief (p=0.10), pliability (p=0.01), surface area (p=0.004), stiffness (p=0.023), thickness (0.011) and scar irregularity (p=0.011). Regarding erythema and melanin, viscoelasticity and pliability, trans-epidermal water loss or laser tissue oxygen saturation, haemoglobin level and microcirculation we found no significant differences for treated and untreated skin in the EDNX group.
  
  
  CONCLUSIONS
  In our current study we found Bromelain based enzymatic debridement better in some aspects of tissue preservation in deep dermal facial burn.
authors.affiliation: Department of Plastic Surgery, Hand Surgery, Burn Center, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany. Electronic address: schulza@kliniken-koeln.de.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Schulz
authors.affiliation: Department of Plastic Surgery, Hand Surgery, Burn Center, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany.
authors.forename: Paul Christian
authors.initials: PC
authors.lastname: Fuchs
authors.affiliation: Department of Plastic Surgery, Hand Surgery, Burn Center, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany.
authors.forename: Irene
authors.initials: I
authors.lastname: Rothermundt
authors.affiliation: Department of Plastic Surgery, Hand Surgery, Burn Center, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Hoffmann
authors.affiliation: Department of Plastic and Reconstructive Surgery and Burn Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel.
authors.forename: Lior
authors.initials: L
authors.lastname: Rosenberg
authors.affiliation: Department of Plastic and Reconstructive Surgery and Burn Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Shoham
authors.affiliation: Department of Plastic Surgery, Hand Surgery, Burn Center, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany.
authors.forename: Henrik
authors.initials: H
authors.lastname: Oberländer
authors.affiliation: Department of Plastic Surgery, Hand Surgery, Burn Center, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Schiefer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001963:Bromelains / Q000627:therapeutic use*; D002056:Burns / Q000628:therapy*; D002921:Cicatrix; D003646:Debridement / Q000379:methods*; D020405:Dermis; D005151:Facial Injuries / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments; D062326:Re-Epithelialization; D016038:Skin Transplantation / Q000706:statistics & numerical data; D014945:Wound Healing; D055815:Young Adult
chemical_list: D001963:Bromelains
keywords: Bromelain; Burn eschar; Deep dermal facial burn; Dermis preservation; Enzymatic debridement; Objective and subjective long term scar evaluation