{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T12:11:36Z","timestamp":1788783096844,"version":"build-2803163510"},"reference-count":21,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur. Burn J.","EBJ"],"abstract":"<jats:p>Introduction: Early debridement of burn eschar is a cornerstone of care for patients with extensive burns, yet early large-area surgical excision may be limited by blood loss, physiological instability, and substantial logistical demands. Evidence on bromelain-based enzymatic debridement involving treatment areas greater than 15% total body surface area (TBSA) remains scarce. Case Report: A 38-year-old man sustained partial- and full-thickness burns involving 97% TBSA, together with inhalation injury. Sequential enzymatic debridement with NexoBrid was performed at the bedside in five 4-h sessions under intensive care conditions, with 14\u201327% TBSA treated per session. Complete eschar removal was achieved within 64 h of admission without transfer to the operating room, major procedure-related bleeding, or transfusion during the debridement period. The subsequent course was complicated by sepsis and severe respiratory failure requiring veno-venous extracorporeal membrane oxygenation. Following intensive care treatment, the patient stabilized markedly, ECMO support was discontinued, and near-complete wound coverage was achieved. He died on hospital day 87 following acute intrapulmonary and endotracheal hemorrhage of unclear etiology. Conclusions: This case illustrates the technical feasibility of early, sequential bedside enzymatic debridement in a near-total burn and may inform its carefully selected off-label use in highly specialized burn centers.<\/jats:p>","DOI":"10.3390\/ebj7030046","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T10:30:46Z","timestamp":1788777046000},"page":"46","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sequential Bromelain-Based Enzymatic Debridement in a Near-Total (97%) TBSA Burn: A Case Report"],"prefix":"10.3390","volume":"7","author":[{"given":"Jannik","family":"Hinzmann","sequence":"first","affiliation":[{"name":"Department of Plastic Surgery, BG University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, 44789 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonja Verena","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, BG University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, 44789 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabete","family":"Macedo Santos","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, BG University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, 44789 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Fueth","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, BG University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, 44789 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marius","family":"Drysch","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, BG University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, 44789 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonca","family":"Steubing","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, BG University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, 44789 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Wallner","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, BG University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, 44789 Bochum, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S363","DOI":"10.1093\/jbcr\/iraf019.483","article-title":"952 Global Characteristics and Outcomes of Massive Burn Injuries","volume":"46","author":"Najafali","year":"2025","journal-title":"J. Burn Care Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1097\/SLA.0000000000000438","article-title":"Benchmarking Outcomes in the Critically Injured Burn Patient","volume":"259","author":"Klein","year":"2014","journal-title":"Ann. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2349","DOI":"10.1056\/NEJMra1807442","article-title":"Management of Burns","volume":"380","author":"Greenhalgh","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1093\/jbcr\/irae049","article-title":"Pathophysiology of Severe Burn Injuries: New Therapeutic Opportunities From a Systems Perspective","volume":"45","author":"Dobson","year":"2024","journal-title":"J. Burn Care Res."},{"key":"ref_5","first-page":"197","article-title":"Ultra-Early versus Early Excision and Grafting for Thermal Burns up to 60% Total Body Surface Area; A Historical Cohort Study","volume":"4","author":"Keshavarzi","year":"2016","journal-title":"Bull. Emerg. Trauma"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1816","DOI":"10.1016\/j.burns.2023.06.003","article-title":"Early wound excision within three days decreases risks of wound infection and death in burned patients","volume":"49","author":"Corona","year":"2023","journal-title":"Burns"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1097\/SLA.0000000000006626","article-title":"Optimal Timing and Approaches for First Tangential Excision in Patients with \u226570% TBSA Burns: Insights from a Retrospective Cohort of a Mass Casualty Incident","volume":"283","author":"Huang","year":"2025","journal-title":"Ann. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S206","DOI":"10.1093\/jbcr\/irac012.349","article-title":"800 Immediate\/Ultra-Early v. Early Burn Excision: A Systematic Review of Surgical Outcomes","volume":"43","author":"Lagziel","year":"2022","journal-title":"J. Burn Care Res."},{"key":"ref_9","doi-asserted-by":"crossref","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":"ref_10","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1093\/jbcr\/irae172","article-title":"Bromelain-Based Enzymatic Debridement Versus Standard of Care in Deep Burn Injuries: A Systematic Review and Meta-Analysis","volume":"46","author":"Reginato","year":"2025","journal-title":"J. Burn Care Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1093\/jbcr\/iraa051","article-title":"The Enzymatic Debridement for the Treatment of Burns of Indeterminate Depth","volume":"41","author":"Bernagozzi","year":"2020","journal-title":"J. Burn Care Res."},{"key":"ref_12","unstructured":"European Medicines Agency (2026, August 31). NexoBrid: EPAR-Product Information. Available online: https:\/\/www.ema.europa.eu\/en\/documents\/product-information\/nexobrid-epar-product-information_en.pdf."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1016\/j.burns.2020.10.012","article-title":"Safety of enzymatic debridement in extensive burns larger than 15% total body surface area","volume":"47","author":"Hofmaenner","year":"2021","journal-title":"Burns"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/S0196-0644(82)80096-6","article-title":"The abbreviated burn severity index","volume":"11","author":"Tobiasen","year":"1982","journal-title":"Ann. Emerg. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"4364","DOI":"10.1111\/iwj.14308","article-title":"Bromelain-based enzymatic burn debridement: A systematic review of clinical studies on patient safety, efficacy and long-term outcomes","volume":"20","author":"Shoham","year":"2023","journal-title":"Int. Wound J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1093\/jbcr\/iry009","article-title":"An Overview of the Use of Bromelain-Based Enzymatic Debridement (Nexobrid\u00ae) in Deep Partial and Full Thickness Burns: Appraising the Evidence","volume":"39","author":"Loo","year":"2018","journal-title":"J. Burn Care Res."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Kaita, Y., Nakajima, M., Matsuda, T., and Yamaguchi, Y. (2025). Association of Combined Enzymatic and Surgical Debridement with Clinical Outcomes in Extensive Burn Patients. J. Clin. Med., 14.","DOI":"10.3390\/jcm14155233"},{"key":"ref_18","first-page":"23","article-title":"Delayed and fractional use of enzymatic debridement with nexobrid for extensive burn injury: A case report","volume":"31","author":"Krauss","year":"2018","journal-title":"Ann. Burn. Fire Disasters"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1016\/j.burns.2021.07.023","article-title":"Enzymatic debridement in critically injured burn patients\u2014Our experience in the intensive care setting and during burn resuscitation","volume":"48","author":"Bowers","year":"2022","journal-title":"Burns"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e001304","DOI":"10.1136\/tsaco-2023-001304","article-title":"Antibiotic prophylaxis in injury: An American Association for the Surgery of Trauma Critical Care Committee clinical consensus document","volume":"9","author":"Appelbaum","year":"2024","journal-title":"Trauma Surg. Acute Care Open"},{"key":"ref_21","unstructured":"Deutsche Gesellschaft f\u00fcr Verbrennungsmedizin (2026, August 25). Behandlung von thermischen Verletzungen bei Erwachsenen, S2k-Leitlinie, AWMF-Registernummer 044-001, Version 8.0. Available online: https:\/\/register.awmf.org\/de\/leitlinien\/detail\/044-001."}],"container-title":["European Burn Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2673-1991\/7\/3\/46\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:25:45Z","timestamp":1788780345000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2673-1991\/7\/3\/46"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,7]]},"references-count":21,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["ebj7030046"],"URL":"https:\/\/doi.org\/10.3390\/ebj7030046","relation":{},"ISSN":["2673-1991"],"issn-type":[{"value":"2673-1991","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,7]]}}}