Debriding Burns with Enzymes
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.
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.
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.