Successful treatment of mixed depth flame burns using enzymaticdebridement with Nexobrid™ in a patient with aggressive systemic sclerosis(scleroderma)

Introduction: Enzymatic debridement for mixed depth and full thickness burns is gainingrecognition as an important technique available to the burns surgeon.Reductions in blood loss, the need for autologous skin grafting and thenumber of wounds requiring surgical excision are among the benefits of thisevolving treatment modality. We present a case of successful treatment usingenzymatic debridement of mixed depth flame burns in a young patient withsystemic sclerosis (scleroderma). Methods: A 24-year-old man with rapidly progressive limited cutaneous systemicsclerosis suffered approximately 6% mixed depth flame burns to the right legincluding areas of likely deep partial thickness burn totallingapproximately 2% total body surface area (TBSA). Enzymatic debridement usingNexobrid™ was performed under spinal anaesthesia in accordance with unitprotocol. Pain was well controlled and at 4 h the Nexobrid™ was removed andreplaced with saline-soaked gauze initially then simple dressings. Afterliaison with Rheumatology, he was also started on iloprost infusions overfive days. He was discharged home on day 9 and completely healed by day 31.Scarring was minimal, the skin was soft and full, and pain-free range ofmovement of the right knee was maintained. Discussion and Conclusion: This case demonstrates the safety and effectiveness of enzymatic debridementof mixed depth burns in a patient with very compromised wound healing.Enzymatic debridement combined with iloprost infusion provided maximumpreservation of viable dermis. The authors recommend that this treatmentstrategy is considered in similar cases.