Systemic and Histopathological Effects of Bromelain-Based Enzymatic Debridement in Human Burns-A Systematic Review.
- 1Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iași, Romania.
- 2Department of Plastic Surgery and Reconstructive Microsurgery, Sf. Spiridon Emergency County Hospital, 700111 Iasi, Romania.
- 3Department of Dermatology, Sf. Spiridon Emergency County Hospital, 700111 Iasi, Romania.
Abstract
Background/Objectives: Bromelain-based enzymatic debridement (NexoBrid®) is an established tissue-preserving alternative to tangential excision in deep partial-thickness burns. Its clinical efficacy is supported by randomised trials, but its systemic effects are inconsistently described and its effects at tissue level in humans are largely unknown. The objective was to synthesise the human evidence on both domains and to determine, as a prespecified endpoint, whether any study has evaluated them in the same patients. Methods: PubMed, Embase and Scopus were searched between 2016 and 2026 using two stream-specific strategies that shared their intervention and population blocks and differed only in their outcome block: Stream A, clinical outcomes reported with systemic biological parameters; Stream B, clinical outcomes reported with histopathological findings. Eligible studies were original human investigations published in the last ten years. Risk of bias was assessed with ROBINS-I and the JBI checklists, and the synthesis was narrative, following PRISMA 2020 and SWiM. Results: Of 559 records, twelve studies were included: ten in Stream A (970 patients) and two in Stream B (nine patients); no study identified by the present search met the criteria of both. C-reactive protein and procalcitonin were significantly higher after enzymatic than after surgical debridement throughout the first week, and, in the single study that analysed the treated area as a continuous exposure, the probability of a post-debridement coagulation alteration rose with the area treated (odds ratio 1.158 per percentage point of body surface). Early fever occurred in 14% of patients and predicted later wound infection. Both histological studies were purely qualitative: neither reported a thickness, a percentage or a cell count, and neither reported any laboratory value. Conclusions: Enzymatic debridement is associated with a measurable systemic response whose proposed mechanisms are all statements about tissue that has never been examined. The two literature fields describe the same process at two levels of observation, in different patients and at incompatible times. No validated instrument exists for quantifying the human burn biopsy after debridement.
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BibTeX
@article{gologan2026systemic,
title = {{Systemic and Histopathological Effects of Bromelain-Based Enzymatic Debridement in Human Burns-A Systematic Review.}},
author = {Andrei-Nicolae Gologan and Mihai-Codrin Constantinescu and Dan-Cristian Moraru and Stefana Avadanei-Luca and Alexandru-Hristo Amarandei and Dimitrie-Stefan Gologan and Bianca-Beatrice Carausu and Delia-Gabriela Ciobanu-Apostol and Mihaela Pertea},
journal = {Medical sciences (Basel, Switzerland)},
year = {2026},
month = oct,
doi = {10.3390/medsci14060667},
url = {https://europepmc.org/article/MED/42930587},
note = {CC BY},
}
RIS
TY - JOUR
TI - Systemic and Histopathological Effects of Bromelain-Based Enzymatic Debridement in Human Burns-A Systematic Review.
AU - Andrei-Nicolae Gologan
AU - Mihai-Codrin Constantinescu
AU - Dan-Cristian Moraru
AU - Stefana Avadanei-Luca
AU - Alexandru-Hristo Amarandei
AU - Dimitrie-Stefan Gologan
AU - Bianca-Beatrice Carausu
AU - Delia-Gabriela Ciobanu-Apostol
AU - Mihaela Pertea
PY - 2026
DA - 2026/10/13
JO - Medical sciences (Basel, Switzerland)
DO - 10.3390/medsci14060667
UR - https://europepmc.org/article/MED/42930587
AB - Background/Objectives: Bromelain-based enzymatic debridement (NexoBrid®) is an established tissue-preserving alternative to tangential excision in deep partial-thickness burns. Its clinical efficacy is supported by randomised trials, but its systemic effects are inconsistently described and its effects at tissue level in humans are largely unknown. The objective was to synthesise the human evidence on both domains and to determine, as a prespecified endpoint, whether any study has evaluated them in the same patients. Methods: PubMed, Embase and Scopus were searched between 2016 and 2026 using two stream-specific strategies that shared their intervention and population blocks and differed only in their outcome block: Stream A, clinical outcomes reported with systemic biological parameters; Stream B, clinical outcomes reported with histopathological findings. Eligible studies were original human investigations published in the last ten years. Risk of bias was assessed with ROBINS-I and the JBI checklists, and the synthesis was narrative, following PRISMA 2020 and SWiM. Results: Of 559 records, twelve studies were included: ten in Stream A (970 patients) and two in Stream B (nine patients); no study identified by the present search met the criteria of both. C-reactive protein and procalcitonin were significantly higher after enzymatic than after surgical debridement throughout the first week, and, in the single study that analysed the treated area as a continuous exposure, the probability of a post-debridement coagulation alteration rose with the area treated (odds ratio 1.158 per percentage point of body surface). Early fever occurred in 14% of patients and predicted later wound infection. Both histological studies were purely qualitative: neither reported a thickness, a percentage or a cell count, and neither reported any laboratory value. Conclusions: Enzymatic debridement is associated with a measurable systemic response whose proposed mechanisms are all statements about tissue that has never been examined. The two literature fields describe the same process at two levels of observation, in different patients and at incompatible times. No validated instrument exists for quantifying the human burn biopsy after debridement.
SN - 2076-3271
ER -