Burn Care in the Era of Rapid Enzymatic Debridement: Challenging the Dogma that Healing Beyond 21 Days Results in Hypertrophic Scarring

Deep burns are characterized by the presence of a necrotic eschar that delays healing and results in local systemic inflammatory response following secondary intention: heavy scarring. Early surgical debridement followed grafting was major advance deep burn care is now standard care, reducing mortality hypertrophic Eschars have alternatively been managed non-surgical, autolytic debridement, which often infection-inflammation, slow epithelialization, granulation tissue formation subsequent Studies based on these traditional approaches demonstrated an association between delayed wound closure (beyond 21 days) enzymatic with NexoBrid (NXB) appropriate novel minimally invasive modality challenges well-accepted dictum high risk scarring associated extends beyond days. This not surprising since early selective removal only leaves enough viable dermis skin appendages to allow epithelialization over dermis. In absence tissue, similar clean dermal wounds (like many donor sites) intention If when islands start appear epithelializing dermis, they generally can be controlled short courses (1-3 topically applied low strength corticosteroid ointments minimizing scarring, albeit magic number Results from multiple studies field experience confirm while require more than days reepithelialize, long-term cosmetic at least as good excision grafting.