Efficacy and Safety of Bromelain-Based Enzymatic Debridement for Chronic Wounds: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

Bromelain-based enzymatic debridement (BBD) may selectively remove devitalised tissue in chronic wounds, but randomised evidence is limited. Following PRISMA and a PROSPERO-registered protocol (CRD420251116455), we searched MEDLINE, CENTRAL and Embase from inception to 8 Aug 2025 for randomised controlled trials in adults with chronic wounds comparing topical BBD versus standard care/vehicle. Two reviewers screened, extracted and assessed risk of bias. Primary outcomes were incidence of complete debridement (efficacy) and ≥ 1 adverse event (safety). Of 24 records, 3 RCTs (n = 314) met inclusion; 2 contributed complete-debridement data and 3 contributed adverse-event data. BBD increased complete debridement versus control (RR 2.81, 95% CI 1.15-6.86; I2 = 58.7). Safety was comparable (RR 1.02, 95% CI 0.76-1.36; I2 = 0), and leave-one-out analyses for adverse events showed no influential study. BBD improves the likelihood of complete debridement without increasing adverse events, suggesting a possible role in its use as a selective, non-surgical adjunct alongside guideline-directed care.