Abstract
A 73-year-old man, critically injured in a burn incident resulting from cooking gas explosion, was transferred by helicopter ambulance to Shimane Prefectural central hospital. Upon arrival, the patient was intubated. The Total Burn Surface Area (TBSA) was 84%, mainly with Deep Burns (DB), and the Prognostic Burn Index (PBI) was 150. We performed enzymatic debridement on the maximum insurance coverage of 30% Burn Surface Area (BSA) in total with topical agent Nexobrid (Kaken Pharmaceutical Co.,Ltd.), a concentrate of proteolytic enzymes extracted from pineapple stem, launched in Japan in August, 2023. Nexobrid only removes nonviable necrotic tissue or eschar in Deep Dermal Burns (DDB) and DB even in the early period after trauma, when accurate evaluation of burn depth is often challenging. Early accurate debridement raises the possibility of dermal preservation, which is important for spontaneous epithelization, and wound bed preparation if skin graft is needed. While the patient died of circulatory failure 4 days after trauma, our experience suggests that Nexobrid is an early, accurate, and less-invasive alternative in debridement, and may assist treatment for burns that affected larger area with surgical debridement combination. However, additional experiences and follow-ups are required to susbtantiate its benefit.
https://ror.org/03rq2h425 
