In many burns units mixed depth and deep dermal facial burns are managed with several weeks of dressings to allow partial healing, followed by grafting unhealed areas. Selective debridement of burns is possible using enzymatic debridement (Nexobrid) using bromelain-based proteolytic enzymes. In our unit autologous cell suspension (ReCell) is used for mixed-depth and deep facial burns as standard of care, with or without skin grafting depending on depth of dermal injury.
Purpose: To review early outcomes of patients with mixed-depth and deep facial burns treated with Nexobrid debridement and ReCell in adult patients in Western Australia.
Methodology: Deep flame facial burns treated with early Nexobrid debridement and Recell were retrospectively reviewed. Patient demographics, burn and intervention details were recorded along with time to healing and scar outcomes and photography.
Results: Four patients underwent Nexobrid debridement for deep dermal facial burns within 48 hours of injury from 2023 to present. Mean %TBSA burn was 45.3% (20-68%). Autologous cell suspension (ReCell) was performed within the first week post-debridement +/- grafting of unhealed areas at 2-3 weeks post-injury. Time to complete healing of facial wounds ranged from 16 to 35 days and follow up ranged from 2-21 months.
Conclusion: Early facial burn debridement with Nexobrid and ReCell is now considered for all intubated adult facial burns at our unit. We believe that the combination of Nexobrid and ReCell allows earlier, accurate removal of the toxic burn load, less inflammation and allows dermal preservation and earlier wound closure.