Enzymatic debridement of deep facial burns with Nexobrid™: the Queen Victoria Hospital experience

Background Deep facial burns present unique challenges due to the risk of scarring and contracture which can negatively impact patients' cosmesis and function. Enzymatic debridement of burns with bromelain-based agents, such as Nexobrid (TM), may improve scarring through maximal preservation of viable tissue. However, Nexobrid (TM) use in facial burns is poorly described in the literature.Methods We conducted a single-centre case series, retrospectively reviewing all patients treated with Nexobrid (TM) for deep facial burns between January 2016 and July 2022.Results We identified five female patients aged 27-69 with 1-6% deep burns of different aetiologies (flame, contact and flash flame). All patients received Nexobrid (TM) within 72 hours of injury and underwent allograft application the following day. Length of hospital stay ranged from 3 to 10 days (mean 4.6). Four out of five patients underwent delayed autograft at 15 to 29 days (mean 25), and the time to complete healing varied from 24 to 93 days (mean 52). Patients displayed good aesthetic and functional outcomes at follow-up ranging from 3 to 36 months.Conclusions From our experience at Queen Victoria Hospital, we observed good aesthetic and functional outcomes using Nexobrid (TM) in deep facial burns. The process is safe and effective, and we hope that our contribution will encourage further research and practice in this field.