Sequential Bromelain-Based Enzymatic Debridement in a Near-Total (97%) TBSA Burn: A Case Report.

Introduction

Early debridement of burn eschar is a cornerstone of care for patients with extensive burns, yet early large-area surgical excision may be limited by blood loss, physiological instability, and substantial logistical demands. Evidence on bromelain-based enzymatic debridement involving treatment areas greater than 15% total body surface area (TBSA) remains scarce. Case Report: A 38-year-old man sustained partial- and full-thickness burns involving 97% TBSA, together with inhalation injury. Sequential enzymatic debridement with NexoBrid was performed at the bedside in five 4-h sessions under intensive care conditions, with 14-27% TBSA treated per session. Complete eschar removal was achieved within 64 h of admission without transfer to the operating room, major procedure-related bleeding, or transfusion during the debridement period. The subsequent course was complicated by sepsis and severe respiratory failure requiring veno-venous extracorporeal membrane oxygenation. Following intensive care treatment, the patient stabilized markedly, ECMO support was discontinued, and near-complete wound coverage was achieved. He died on hospital day 87 following acute intrapulmonary and endotracheal hemorrhage of unclear etiology.

Conclusions

This case illustrates the technical feasibility of early, sequential bedside enzymatic debridement in a near-total burn and may inform its carefully selected off-label use in highly specialized burn centers.