Burn Wounds and Enzymatic Debridement (ED)—Past, Present, and Future.

This article focuses on enzymatic debridement (ED) as a treatment modality for burn wounds, reviewing its historical development, current clinical applications, and emerging agents. Surgical early tangential excision remains the standard of care (SOC) for deep burns but has drawbacks such as blood loss and removal of viable tissue. Bromelain-based debridement (BBD), derived from pineapple extract and commercially available as NexoBrid, is currently the most widely used enzymatic agent, showing promising selective eschar removal and reduced surgical burden in numerous clinical studies from 2020 to 2023. Although BBD is effective and safe with appropriate pain management, evidence does not yet support replacing surgical SOC with ED; rather, ED is considered a valuable adjunct in burn care. New enzymatic agents like keratinase and SN514 gel show potential but require further clinical investigation before adoption.