{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T02:24:45Z","timestamp":1778811885148,"version":"3.51.4"},"reference-count":96,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2024,4,8]],"date-time":"2024-04-08T00:00:00Z","timestamp":1712534400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Excision of necrotic and devitalized tissues of deep burns is key for optimal care of burn injuries. However, the modality of early tangential excision followed by skin grafting proposed by Zora Janzekovic 5 decades ago was not received initially with great enthusiasm. At present, it developed to become the standard of care (SOC) despite the special expertise it necessitates and the general anesthesia it requires in addition to several drawbacks including excessive blood loss, risk of hypothermia, and most importantly potential excision of normal non-burned tissues. Conservative non-surgical selective enzymatic debridement (ED) at present is becoming more popular as an adjunct or even an alternative approach.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A systematic review of the PubMed electronic database was conducted to identify all experimental and clinical studies about ED of burn wounds. Additional separate searches were also conducted to identify any reports missed by the initial systematic review. Full texts of 59 reports (42 clinical and 17 experimental studies) were retrieved for analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 46 studies (11 experimental and 35 clinical) were about the pineapple extract debriding agent. In total, 23 clinical studies describing promising favorable results with pineapple bromelain-based debridement (BBD) concentrate were published in the last 3 years (2020-2023).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Though available evidence is not entirely in favor of replacing the current surgical SOC with BBD, it certainly presents ED as a highly advantageous modality for the management of burn wounds. Newly described keratinase and SN514 also are promising new products. They both still await further investigation before being clinically adopted.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jbcr\/irae059","type":"journal-article","created":{"date-parts":[[2024,4,8]],"date-time":"2024-04-08T08:23:35Z","timestamp":1712564615000},"page":"864-876","source":"Crossref","is-referenced-by-count":6,"title":["Burn Wounds and Enzymatic Debridement (ED)\u2014Past, Present, and Future"],"prefix":"10.1093","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8650-491X","authenticated-orcid":false,"given":"Bishara","family":"Atiyeh","sequence":"first","affiliation":[{"name":"Department of Surgery, American University of Beirut, Division of Plastic and Reconstructive Surgery , 1107 2020, Beirut , Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8057-3284","authenticated-orcid":false,"given":"Kareem","family":"Makkawi","sequence":"additional","affiliation":[{"name":"Department of Surgery, American University of Beirut, Division of Plastic and Reconstructive Surgery , 1107 2020, Beirut , Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3662-3491","authenticated-orcid":false,"given":"Paul","family":"Beaineh","sequence":"additional","affiliation":[{"name":"Department of Surgery, American University of Beirut, Division of Plastic and Reconstructive Surgery , 1107 2020, Beirut , Lebanon"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,4,8]]},"reference":[{"key":"2024080703331631600_CIT0001","first-page":"1224","article-title":"Clinical value of debriding enzymes as an adjunct to standard early surgical excision in human burns: a systematic review","volume-title":"J Burn Care Res","author":"Salehi","year":"2020"},{"key":"2024080703331631600_CIT0002","first-page":"706","article-title":"Historical perspectives on the development of current standards of care for enzymatic debridement","volume-title":"Medicina (Kaunas)","author":"Heitzmann","year":"2020"},{"key":"2024080703331631600_CIT0003","first-page":"1185","article-title":"Anacaulase-bcdb for the treatment of severe thermal burns","volume-title":"Expert Opin Biol Ther","author":"Shoham","year":"2023"},{"key":"2024080703331631600_CIT0004","first-page":"232","article-title":"Evidence and trends in burn wound debridement: an evidence map","volume-title":"Plast Surg (Oakv)","author":"Ziegler","year":"2020"},{"issue":"12","key":"2024080703331631600_CIT0005","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1097\/00005373-197012000-00001","article-title":"A new concept in the early excision and immediate grafting of burns","volume":"10","author":"Janzekovic","year":"1970","journal-title":"J Trauma"},{"key":"2024080703331631600_CIT0006","first-page":"279","article-title":"Enzymatic debridement: past, present, and future","volume-title":"Acta Chir Belg","author":"De Decker","year":"2022"},{"issue":"3","key":"2024080703331631600_CIT0007","first-page":"239","article-title":"Does enzymatic debridement allow us to perform conservative treatment on clinically deep hand burns? 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