Enzymatic Débridement of Burn Wounds

Summary

Principles for the use of exogenous enzymes as débriding agents for burn wounds are briefly discussed. These agents may be utilized in an attempt to accelerate the removal of devitalized tissue from the wound, and this action will hopefully promote wound closure. Past experience has demonstrated that partial-thickness burn wounds which close quickly heal with less hypertrophic scar than wounds which close more slowly. Since 75% of the dry weight of skin is composed of collagen, exogenous collagenase preparations may prove useful for the débridement of burn wounds. We describe a recent clinical study of the use of a collagenase derived from the bacterium Clostridium histolyticum. Seventy-six patients were studied at seven different United States burn centers. Paired partial-thickness wounds in each patient were treated with silver sulfadiazine or collagenase ointment. The use of collagenase ointment resulted in more rapid removal of debris from the wound surface and more rapid epithelialization of the wounds compared with silver sulfadiazine, with statistical significance achieved for both end points (P < 0.001). In addition, wounds treated with collagenase ointment were not found to produce more discomfort than wounds treated with silver sulfadiazine, and infection incidences were not different. After completion of the multicenter study, we actively examined the use of collagenase ointment for treating other types of wounds in burn patients, including infected donor sites and chronic, slowly healing partial-thickness burns, and have found it efficacious. Continued study of enzymatic débriding agents for wounds in burn patients will hopefully delineate techniques which will encourage wound closure while simultaneously decreasing the intensity and expense of wound care.