Bordeanu-Diaconescu Eliza-Maria, Grama Sabina, Grosu-Bularda Andreea, Frunza Adrian, Andrei Mihaela-Cristina, Neagu Tiberiu-Paul, Lascar Ioan
Department 11, Discipline Plastic and Reconstructive Surgery, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania.
Burn Centre, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania.
Eur Burn J. 2024 Dec 12;5(4):438-453. doi: 10.3390/ebj5040039.
The management of severe burns is a complex process that requires a multidimensional approach to ensure optimal healing of burn wounds, minimize complications, and improve the prognosis of patients. Surgical debridement is considered the gold standard for removing necrotic tissue; however, this approach involves risks such as bleeding, the potential removal of viable tissue during excision, and technical challenges in complex anatomical areas. Recent advancements highlight the role of enzymatic debridement using NexoBrid, which offers a less invasive alternative to surgical excision while having the ability to selectively debride necrotic tissue and preserve viable tissue. NexoBrid has shown efficacy in reducing debridement time, minimizing the need for additional surgeries, and improving overall wound healing outcomes. This review discusses the clinical indications, advantages, and considerations for choosing between surgical and enzymatic debridement. Emerging studies suggest the potential for enzymatic debridement to be safe and effective even for larger burn areas, making it a promising option in modern burn care. However, ongoing evaluation and integration into clinical protocols will be essential to fully realize its benefits in specialized burn treatment and to establish protocols.
严重烧伤的管理是一个复杂的过程，需要多维度的方法来确保烧伤创面的最佳愈合、将并发症降至最低并改善患者的预后。手术清创被认为是去除坏死组织的金标准；然而，这种方法存在出血、切除过程中可能去除存活组织以及复杂解剖区域的技术挑战等风险。最近的进展突出了使用NexoBrid进行酶促清创的作用，它为手术切除提供了一种侵入性较小的替代方法，同时能够选择性地清除坏死组织并保留存活组织。NexoBrid已显示出在减少清创时间、减少额外手术需求以及改善整体伤口愈合结果方面的疗效。本综述讨论了手术清创和酶促清创之间的临床适应症、优势以及选择时的考虑因素。新兴研究表明，即使对于较大面积的烧伤，酶促清创也有安全有效的潜力，使其成为现代烧伤护理中有前景的选择。然而，持续评估并将其纳入临床方案对于在专业烧伤治疗中充分实现其益处并建立方案至关重要。
