Debriding Burns with Enzymes

One of the keys to good burn management is to get rid of the dead and devitalized tissue created by the burn.  It is necessary to get rid of the eschar (thick leathery covering) so as to prevent infections and poor wound healing.  If there are full thickness burns covering greater than 50 percent of the total body surface area, removal of the burn eschar can save the person’s life.  This should be done as soon as possible unless the wound is of an uncertain depth.  In such cases, the eschar can be allowed to develop and can be removed about 3 days after the injury.
 
The removal of the eschar in the above cases (called debridement) is generally done through surgery but it has the disadvantage of removing quite a bit of healthy tissue as well and this can affect the overall appearance of the wound after it has healed.  In addition, a donor site on the individual must be selected and used to cover the debrided burn.  This is further debilitating and unsightly, and may not be able to be done well if a great deal of burn surface area of the body is involved.
 
Nonsurgical Debridement
 
This involves a more conservative approach and depends on macerating the wound, applying antimicrobial agents and daily cleansing of the wound while scraping off the dead tissue.  The wound often is also debrided by infecting organisms that chew away at dead tissue, hopefully sparing the good tissue around it.  It is a slow process lasting up to two weeks or so and can involve local and systemic complications.  The eschar will eventually slough off.  It can take so long that granulation tissue can develop, which generally turns into thick, unsightly scars.
 
This technique has some advantages, however.  It is simple and relatively inexpensive when compared to surgery.  It also does not cause as much loss of healthy tissue as happens with surgical methods.  After this type of debridement, the usual process is one of re-building tissue and skin spontaneously.  Even so, there are complications of infection and poor appearance to consider.
 
Enzymatic Debridement
 
This type of debridement can be beneficial because it avoids surgery and is quicker than simply letting the eschar fall off.  It has been used in the past; for example, papain was used in the 1940s for burn care when added with urea and chlorophyll.  It is still in use in other parts of the world but requires a daily application of ointment or cream for as much as three weeks.  Acids were used in the 1960s but were not found to be better than surgical excision of burn wounds.
 
Researchers developed enzymes that were derived from bacteria such as Clostridium histolyticum, streptococcal and pseudomonas species but were found to be unhelpful.  Collagenase has been in use since the 1950s and is still in use by some practitioners.  It is an ointment derived from Clostridium histolyticum and is marketed as Santyl®.  It takes up to two weeks, however, for full debridement of many types of burns.  It only works on skin and doesn’t work on deeper tissues.
 
Trypsin and related enzymes were harvested from blow flies and fig tree sap but were also found to be too slow and too inefficient to be effective.  All available enzymatic treatments found today are still inferior to surgical debridement because they do not act fast enough.  They involve multiple dressing changes that can stir up infection and can cause tissue damage.  The longer it takes to remove the eschar, the greater is the chance of building up granulation tissue from hyper-inflammation of the skin and underlying substrate.
 
The newest product on the market is derived from bromelain extracts.  It has been studied in pigs and has been found to preserve vital tissue (or potentially vital tissue) and works faster than other enzymes, often within a few hours.  In one study, 15 percent of wounds treated this way still needed some surgical debridement but it is still better than the 62 percent need for additional surgery with initial non-surgical management.
 
A serious burn is a catastrophe. Anyone who has a serious burn thru the negligence of another should contact an experienced catastrophic injury lawyer.
Client Reviews
  • Me and my wife; had a car accident. We were amazed how easy, professional, friendly attorney Ed Smith is along with his staff. Everybody is amazing. Thank you so much, we are very impressed!
    Sincerely, Alex & Dinah M. ★★★★★
  • Ed Smith and his office team took on a difficult personal injury case on my behalf and for the passenger in my car. Ed is a top- notch attorney. His staff couldn't have been more helpful and kind. No need to look elsewhere. I give Ed Smith my highest recommendation. Beverly ★★★★★
  • Ed and Robert have been taking great care of my husband and I for the past 5+ years. They are always there when you have a problem and a quick resolution! Even when the issues have nothing to do with them. They are willing to help ease the pain off your shoulders. They are as good as it gets! Thank you again for everything. Annie T. ★★★★★
  • Very professional. Great team, staff and service all around. Mr Smith was very honest, straight forward with his advice. He gives the word "attorney" an honest reputation. I will seek his council anytime, and would recommend him at the drop of a dime. Jeremy M. ★★★★★
  • I would highly recommend Ed Smith to any friends or family in need of a personal injury attorney. Ed, and his staff, are very caring on top of being very experienced in this field. The staff always keeps you informed of the status of your case and they are always easy to reach by phone. Shannon D. ★★★★★
  • Edward Smith law offices provide competent, thorough, and personable help for victims of personal injury. When you first meet the staff you know you contacted the right office. This law office treats clients like people. I recommend this office to anyone seeking representation regarding personal injury. David M. ★★★★★