Early and Successful Enzymatıc Debridement Via Collagenase Application to Pinna in a Preterm Neonate Belma Saygili Karagol, M.D., Nurullah Okumus, M.D., Arzu Dursun, M.D., Nilgun Karadag, M.D., and Aysegul Zencıroglu, M.D. Sami Ulus Maternity and Children’s Education and Research Hospital, Division of Neonatology, Ankara, Turkey Abstract: We report early and successful enzymatic debridement using collagenase application to pinna in a preterm neonate. Collagenase clostridiopeptidase A should be kept in mind not only for the removal of eschar but also for avoidance of the progression of necrotic tissue in neonates. Necrotic tissue on the surface of a wound interferes with wound healing and constitutes a suitable medium for the growth of microorganisms. One of the exoge- neous enzymes used for wound debridement is collage- nase clostridiopeptidase A (CCA), which is extracted from Clostridium hystolyticum by fermentation. Here, we report a preterm neonate with necrotic tissue of the pinna that was healed using early enzymatic debridement through CCA application. CASE REPORT A 1,900-g prematurely born (33 wks) female infant with perinatal asphyxia, hypoxic ischemic encephalopathy, respiratory insufficiency, and early-onset neonatal sepsis with multiorgan failure was referred to our neonatal intensive care unit on the third day of life. Physical examination revealed deteriorated general condition with convulsions, hypothermia, bradycardia, and shallow breathing. She was gasping, with cyanosis, and needed resuscitation. Respiratory support with mechanical ventilation, intravenous fluids as a saline bolus, inotro- pic support, and anticonvulsant therapy because of con- vulsions were administered within the first hour of admission. She had a necrotic, 1.4-cm eschar-coated tissue elongating to the upper region of the pinna of the right ear (Fig. 1A). Daily CCA application with wet saline-soaked gauze was initiated immediately without any bacterial agent. Parenteral systemic antibiotic therapy was also started. At the end of the first week after admission, the necrotic tissue of the pinna fell off, leaving a limited scar on the external upper region of the pinna (Fig. 1B). The necrotic tissue did not enlarge any further, and inves- tigation of the etiology revealed no thrombophilic abnormality. We suspect that the necrotic tissue in our patient developed because of sepsis with early purpura fulminans. DISCUSSION The literature contains little about collagenase treatment in children, and there are only two reports of enzymatic Address correspondence to Belma Saygili Karagol, M.D., Mesa Koru Sitesi Mimoza A blok No: 14, 06830 Cayyolu, Ankara, Turkey, or e-mail: belmakaragol@yahoo.com. DOI: 10.1111/j.1525-1470.2011.01546.x 600 Ó 2011 Wiley Periodicals, Inc. TECHNIQUES FOR TOTS Pediatric Dermatology Vol. 28 No. 5 600–601, 2011