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Ziegler et al. Plast Aesthet Res 2018;5:33 I http://dx.doi.org/10.20517/2347-9264.2018.46 Page 5 of 7

Table 1. Overview of literature
Interven- Com- Study Country/
Study Patients (IG/CG) Outcomes (IG/CG) LoE
tion parison type setting
Rosenberg et al. [5] Deep burns n = 74 n = 81 • Time to complete eschar (mean, days): 2.2/8.7 RCT Israel 2
Age (mean): Enzymatic Excisional (P < 0.0001)
32.4/29.3 debride- debride- • Wounds requiring surgical excision
Female: ment with ment 24.5%/70.0% (P < 0.0001)
23.8%/24.7% NexoBrid followed • Autograft: 17.9%/34.1% (P = 0.0099)
TBSA: 11.3%/11.0% by auto- • Time to complete wound closure (days):
grafting 32.8/29.2 (P = 0.1197)
• Blood loss-change in hemoglobinc (mean,
mmol/L): 0.52/1.04 (P = 0.0061)
• Scar quality (mean, Modified Vancouver Scar
Scale, 2-4years): 3.12/ 3.38 (P = 0.88)
• Scar revision/reconstructive surgery
(2-4years): 3.7%/8.6% (P = 0.6547)
• General health (mean SF-36, 2-4years) –
physical score (patients) 51.1 /51.3 (P = 0.68)
• Adverse events: ns differences
Schulz et al. [19] Partial thickness and n = 13 n = 13 • Time of initial debridement (days after admis- Prospective Germany, 3
deep dermal burn Enzymatic historic sion): 0.92/4.92 trial with burn cen-
wounds of the face debride- control • Autografting (wounds): 15%/77% historic ter
age (mean): 39/48 ment with group • Time to complete healing after first debride- control
years NexoBrid treated ment (days): 18.92/35.62
male: 84.6%/76.9% with SOC
TBSA: 16%/34%
Schulz et al. [8] Partial thickness and n = 26 n = 20 • Autografting (wounds): 15%/95% Prospective Germany, 3
deep dermal burn Enzymatic historic • Time to complete healing after admission trial with burn cen-
wounds of the hands debride- control (days): 24.2/35.8 historic ter
age (mean): ment with group • Number of surgeries until complete wound control
41/45.5y. NexoBrid treated closure (includes debridement): 1.15/1.7
male: 95/85% with SOC
TBSA: 10.1/31%
Cordts et al. [7] Full-thickness upper n = 16 NA • Pain (3 months, patient-related) Case series Germany, 4
extremity burns Enzymatic • Wrist Evaluation Score: 23/100 burn inten-
Age (mean): 47.8 debride- • Disabilities of the shoulder, arm and hand: sive care
Females: 31.2 % ment 22/100 unit
TBSA: 20.1% • Scar quality (3 months, Vancouver Scar Scale):
6/14
• Side effects (during hospital stay): 0
• Wound infections (during hospital stay): 0
Schulz et al. [14] Partial thickness and n = 20 NA • Time to complete healing after admission Case series Germany, 4
deep dermal burn Enzymatic (days): 29.15 burn cen-
wounds of the hands debride- • Efficiency of debridement (%): 90% ter
age (mean): 43y. ment with • Autografting (wounds): 30%
male: 85% NexoBrid
TBSA: 15.67%
Krieger et al. [6] n = 69 Selective NA • Complete wound closure (mean, days): 17 Case series Israel, hos- 4
Deeply burned hand enzymatic (surgery), 23 (no surgery) pital (burn
TBSA: 1.4% debride- • Surgical escharotomy: 0 unit)
ment • Permanent damage: 0
Rosenberg et al. [4] n = 130 Enzymatic NA • Significant adverse events: 0 Case series Israel, 4
Deep second degree debride- hospital
and third degree ment with
burns Bromelain-
Age (mean): 18.6 derived
Female: 48.5% debriding
TBSA < 10%: 66% agent

[17]
shown by Osinga et al. who presented a series of 12 cases. While ED is most commonly used within 72 h
after trauma the group of Osinga treated their patients with ED up to 19 days after burn trauma and still
[17]
[18]
reported to avoid STSG even in deep burns in the majority of their cases . Edmondson et al. recently
reviewed the literature from 1946 to 2017 for comparison of different tools of eschar removal. While sharp
excision by knife was found to be the predominantly used technique, a robust comparison to newer tools like
ED or Hydrosurgery (VersaJet®) is lacking . Table 1 summarizes the latest literature on ED with given out-
[18]
comes and level of evidence.