Enzymatic debridement of deeply burned faces: Healing and early scarring based on tissue preservation compared to traditional surgical debridement Alexandra Schulz a, * , Paul Christian Fuchs a , Irene Rothermundt a , Alexandra Hoffmann a , Lior Rosenberg b , Yaron Shoham b , Henrik Oberländer a , Jennifer Schiefer a a Department of Plastic Surgery, Hand Surgery, Burn Center, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Cologne, Germany b Department of Plastic and Reconstructive Surgery and Burn Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheba, Israel a b s t r a c t Introduction: Facial burns occur frequently and depending on the injured skin layers often heal with scars which may cause permanent functional and cosmetic sequelae. Preservation of the sensitive facial skin layers, especially of the dermis is essential for scarless epithelialisation. Enzymatic debridement of deep thermal burns has already been shown to assist with preserving viable dermis. However, up to date, there are no published reports on wound healing and in the long term aesthetic outcome after enzymatic debridement of facial burns. Methods: Therefore we performed a—single centre clinical trial that included 26 subjects aged 18 –78 years with facial burns clinically evaluated as deep dermal or deeper. Burns were treated either with enzymatic debridement or excisional surgical debridement. Then we compared both groups regarding debridement selectivity, wound closure and scar quality after more than 12 months. Results: Enzymatic debridement significantly reduced time to complete wound closure after admission (19.85 days versus 42.23 days, p=0.002), and after enzymatic eschar removal (18.92 days versus 35.62 days, p=0.042). The number of procedures to complete debridement were significantly lower in the enzymatic debridement group (1.00 versus 1.77, p=0.003). 77% of facial burns that had been debrided enzymatically were found to be more superficially burned than initially estimated. Wounds undergoing autografting of any size were significantly reduced by enzymatic debridement (15% versus 77%, p=0.002). Scar quality after enzymatic debridement was superior compared to surgical debridement after 12 months regarding pigmentation (p=0.016), thickness (p=0.16), relief (p=0.10), pliability (p=0.01), surface area (p=0.004), stiffness (p=0.023), thickness (0.011) and scar irregularity (p=0.011). Regarding erythema and melanin, viscoelasticity and pliability, trans-epidermal a r t i c l e i n f o Article history: Accepted 24 February 2017 Available online xxx Keywords: Deep dermal facial burn Enzymatic debridement Burn eschar Bromelain Dermis preservation Objective and subjective long term scar evaluation * Corresponding author at: Department of Plastic Surgery, Hand Surgery, Burn Center, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Ostmerheimer Strasse 200, 51109 Cologne, Germany. Fax: +49 211 8907 8314. E-mail address: schulza@kliniken-koeln.de (A. Schulz). http://dx.doi.org/10.1016/j.burns.2017.02.016 0305-4179/© 2017 Elsevier Ltd and ISBI. All rights reserved. b u r n s x x x ( 2 0 1 7 ) x x x – x x x JBUR 5206 No. of Pages 11 Please cite this article in press as: A. Schulz, et al., Enzymatic debridement of deeply burned faces: Healing and early scarring based on tissue preservation compared to traditional surgical debridement, Burns (2017), http://dx.doi.org/10.1016/j.burns.2017.02.016 Available online at www.sciencedirect.com ScienceDirect jo u rn al h o mep age: w ww .elsevier .co m /loc ate/b u rn s