Department of Emergency Medicine, Renaissance School of Medicine at Stony Brook University, New York, USA.
Department of Plastic and Reconstructive Surgery and Burn Unit, Soroka University Medical Center, Ben-Gurion University, Beer Sheba, Israel.
J Burn Care Res. 2023 Mar 2;44(2):408-413. doi: 10.1093/jbcr/irac080.
Surgical excision and grafting of deep partial-thickness (DPT) and full-thickness (FT) burns is a cornerstone of wound care. The use of commercially available topical enzymatic agents has been limited due to slower and less complete eschar removal than surgical excision. Using a porcine model of DPT and FT burns, we compared the eschar removal efficacy of a bromelain-enriched enzymatic agent derived from the stems of pineapple plants and a commercially available collagenase. We created 40 DPT and 40 FT burns on four anesthetized Yorkshire pigs. Eschar removal was initiated 24 hours later. Two pigs each were randomly assigned to collagenase or the bromelain-enriched agent. The bromelain-enriched agent was applied topically once for 4 hours followed by a 2-hour soaking. The collagenase was applied topically daily until complete removal of eschar or for up to 14 days. All bromelain-enriched treated FT burns underwent complete removal of the eschar after a single application while none of the collagenase-treated FT burns underwent complete removal of the eschar even after 14 days of treatment. All bromelain-enriched treated DPT burns had complete eschar removal after the single application. None of the collagenase-treated DPT burns experienced complete removal of eschar after 10 days; by day 14, 35% had complete eschar removal, 30% had >50% eschar removed, and 35% had <50% eschar removed. We conclude that eschar removal is quicker and more complete with the bromelain-enriched compared with collagenase debriding agent.
手术切除和移植深度部分厚度（DPT）和全厚度（FT）烧伤是伤口护理的基石。由于比手术切除更慢且更不完全的焦痂去除，商业上可用的局部酶制剂的使用受到限制。我们使用DPT 和 FT 烧伤的猪模型，比较了从菠萝植物茎中提取的富含菠萝蛋白酶的酶制剂和市售胶原酶的焦痂去除效果。我们在四只麻醉的约克夏猪上创建了 40 个 DPT 和 40 个 FT 烧伤。24 小时后开始去除焦痂。每只猪随机分配到胶原酶或富含菠萝蛋白酶的制剂。富含菠萝蛋白酶的制剂每天应用一次，持续 4 小时，然后浸泡 2 小时。胶原酶每天应用，直至完全去除焦痂或最多 14 天。所有接受富含菠萝蛋白酶的 FT 烧伤的单次应用后，焦痂完全去除，而没有接受胶原酶治疗的 FT 烧伤即使在 14 天的治疗后也未完全去除焦痂。所有接受富含菠萝蛋白酶的 DPT 烧伤的单次应用后，焦痂完全去除。没有接受胶原酶治疗的 DPT 烧伤在 10 天后完全去除焦痂；在第 14 天，35%的焦痂完全去除，30%的焦痂去除了>50%，35%的焦痂去除了<50%。我们的结论是，与胶原酶清创剂相比，富含菠萝蛋白酶的焦痂去除更快、更完全。
