{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T13:17:29Z","timestamp":1777987049106,"version":"3.51.4"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"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":[[2026,5,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Enzymatic debridement with NexoBrid has become a cornerstone of modern burn care due to its selective tissue-sparing properties. However, the optimal timing and strategy for surgical intervention following enzymatic treatment remain debated. We aimed to evaluate the clinical outcomes of the ENGAGE protocol (ENzymatic debridement with NexoBrid, followed by Grafting After Graded early Excision), a structured algorithm integrating enzymatic debridement with scheduled wound reassessment and selective early excision. This before-and-after observational study included adult patients with burn injuries treated with NexoBrid between January 2020 and October 2025 (2020-2022 received standard NexoBrid management; 2023-2025 received the ENGAGE protocol, featuring day-7 reassessment and selective excision). Endpoints included autologous grafting rate, length of hospital stay (LOS), mortality, and number of surgical procedures. Eighty-eight patients were analyzed (27 standard NexoBrid management, 61 ENGAGE). Baseline characteristics and burn etiologies were comparable. The ENGAGE group showed a significantly shorter LOS (mean\u2009\u00b1\u2009SD: 24\u2009\u00b1\u200913.8 vs 32\u2009\u00b1\u200919.2\u00a0days, median: 23 vs 27\u00a0days, P = .03) with no increase in grafting rate (60.7% vs 59.3%, P = .54) or mortality (9.8% vs 7.4%, P &amp;gt; .5). The number of surgical procedures per patient was higher in the ENGAGE group (4.36\u2009\u00b1\u20093.82 vs 2.74\u2009\u00b1\u20093.82, P = .029), reflecting planned early reassessment and targeted intervention rather than increased morbidity. The ENGAGE protocol reduces hospital stay without compromising grafting or survival outcomes. By incorporating early, biologically guided excision after enzymatic debridement, it offers a structured and effective refinement of modern burn wound management.<\/jats:p>","DOI":"10.1093\/jbcr\/irag030","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T12:56:00Z","timestamp":1771505760000},"page":"944-949","source":"Crossref","is-referenced-by-count":0,"title":["The ENGAGE Protocol: Enzymatic Debridement With NexoBrid Followed by Grafting After Graded Early Excision\u2014A Retrospective Cohort Study"],"prefix":"10.1093","volume":"47","author":[{"given":"Giuseppe A G","family":"Lombardo","sequence":"first","affiliation":[{"name":"Burn and Plastic Surgery Unit, Azienda Ospedaliera per l\u2019Emergenza Cannizzaro , Catania, Via Messina 829, 95126, CT ,","place":["Italy"]},{"name":"Universit\u00e0 degli Studi di Enna Kore , Enna, Piazza dell'Universit\u00e0, 94100, EN ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Mollica","sequence":"additional","affiliation":[{"name":"Burn and Plastic Surgery Unit, Azienda Ospedaliera per l\u2019Emergenza Cannizzaro , Catania, Via Messina 829, 95126, CT ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Serafina","family":"Pepe","sequence":"additional","affiliation":[{"name":"Burn and Plastic Surgery Unit, Azienda Ospedaliera per l\u2019Emergenza Cannizzaro , Catania, Via Messina 829, 95126, CT ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dario","family":"Melita","sequence":"additional","affiliation":[{"name":"Burn and Plastic Surgery Unit, Azienda Ospedaliera per l\u2019Emergenza Cannizzaro , Catania, Via Messina 829, 95126, CT ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosario","family":"Ranno","sequence":"additional","affiliation":[{"name":"Burn and Plastic Surgery Unit, Azienda Ospedaliera per l\u2019Emergenza Cannizzaro , Catania, Via Messina 829, 95126, CT ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2108-2979","authenticated-orcid":false,"given":"Paolo","family":"Marchica","sequence":"additional","affiliation":[{"name":"Burn and Plastic Surgery Unit, Azienda Ospedaliera per l\u2019Emergenza Cannizzaro , Catania, Via Messina 829, 95126, CT ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,2,20]]},"reference":[{"key":"2026050508232921500_ref1","volume-title":"Total Burn Care","author":"Kowal-Vern","year":"2012"},{"key":"2026050508232921500_ref2","first-page":"5","article-title":"Burn wound cleansing\u2014a myth or a scientific practice","volume":"18","author":"Atiyeh","year":"2005","journal-title":"Ann Burns Fire Disasters"},{"key":"2026050508232921500_ref3","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1016\/j.burns.2013.08.013","article-title":"A novel rapid and selective enzymatic debridement agent for burn wound management: a multi-center RCT","volume":"40","author":"Rosenberg","year":"2014","journal-title":"Burns"},{"key":"2026050508232921500_ref4","first-page":"e157","article-title":"NexoBrid\u00ae for burn debridement: review of preclinical and clinical studies","volume":"36","author":"Singer","year":"2015","journal-title":"J Burn Care Res"},{"key":"2026050508232921500_ref5","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1093\/jbcr\/irad171","article-title":"Implementing Nexobrid for burn debridement in a major Italian burn center: a retrospective review","volume":"45","author":"Lombardo","year":"2024","journal-title":"J Burn Care Res"},{"key":"2026050508232921500_ref6","first-page":"479","article-title":"Bromelain-based enzymatic debridement: a systematic review and meta-analysis","volume":"47","author":"Kagan","year":"2021","journal-title":"Burns"},{"key":"2026050508232921500_ref7","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1016\/j.burns.2022.12.003","article-title":"Enzymatic debridement for circumferential deep burns: the role of surgical escharotomy","volume":"49","author":"Gr\u00fcnherz","year":"2023","journal-title":"Burns"},{"key":"2026050508232921500_ref8","first-page":"1281","article-title":"Safety and effectiveness of enzymatic debridement with NexoBrid\u00ae: a systematic review","volume":"48","author":"Schulz","year":"2022","journal-title":"Burns"},{"key":"2026050508232921500_ref9","doi-asserted-by":"publisher","first-page":"107366","DOI":"10.1016\/j.burns.2024.107366","article-title":"The effectiveness of tumescent anesthesia in managing pain for enzymatic debridement of burns. A case-control study","volume":"51","author":"Lombardo","year":"2025","journal-title":"Burns"},{"key":"2026050508232921500_ref10","doi-asserted-by":"publisher","first-page":"58","DOI":"10.3390\/ebj6040058","article-title":"Nexobrid use in the elderly","volume":"6","author":"Lugilde Guerbek","year":"2025","journal-title":"Eur Burn J"},{"key":"2026050508232921500_ref11","first-page":"e21","article-title":"Current and emerging treatment strategies for burn wound management","volume":"19","author":"Popp","year":"2019","journal-title":"Eplasty"},{"key":"2026050508232921500_ref12","first-page":"101","article-title":"Factors influencing length of stay in burn patients: the role of early wound closure","volume":"39","author":"Gurfinkel","year":"2018","journal-title":"J Burn Care Res"},{"key":"2026050508232921500_ref13","first-page":"689","article-title":"Selectivity of bromelain-based enzymatic debridement in burn wound management: a histological study","volume":"41","author":"Rosenberg","year":"2015","journal-title":"Burns"}],"container-title":["Journal of Burn Care &amp; Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jbcr\/advance-article-pdf\/doi\/10.1093\/jbcr\/irag030\/67015295\/irag030.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jbcr\/article-pdf\/47\/3\/944\/67015295\/irag030.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jbcr\/article-pdf\/47\/3\/944\/67015295\/irag030.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T12:23:33Z","timestamp":1777983813000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jbcr\/article\/47\/3\/944\/8492928"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,20]]},"references-count":13,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,2,20]]},"published-print":{"date-parts":[[2026,5,5]]}},"URL":"https:\/\/doi.org\/10.1093\/jbcr\/irag030","relation":{},"ISSN":["1559-047X","1559-0488"],"issn-type":[{"value":"1559-047X","type":"print"},{"value":"1559-0488","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,5]]},"published":{"date-parts":[[2026,2,20]]}}}