Case studies in support of enzymatic debridement as a treatment for partial thickness burns

Evidence base to support the use of enzymatic debridement of partial thickness burns is long and varied and dates back as far as 1951. Many studies support the practice of removing burn eschar with either surgical interventions or less invasive methods such as enzymatic debridement when possible. The American Burn Association (2013) consensus statements clearly state that removal of the burn eschar is an effective and important intervention for improving outcomes of cutaneous burns. However, for smaller surface area partial thickness burns, removing burn eschar is largely excluded as a treatment methodology. Clinicians who do not treat burns on a regular basis often focus on antimicrobial therapy but neglect the importance of removing dead tissue, which itself can be a source of infection and impaired healing. This observational case study reviews treatment course of three patients who were initially treated with silver sulfadiazine alone and failed to heal.  After initial failure of silver sulfadiazine alone an enzymatic debriding agent was used to debride the burn eschar with significantly improved outcomes.  Case studies in this presentation include three chronic spinal cord injury patients who received accidental partial thickness burns and whose wound care was later assumed by the SCI certified wound care nurse. Some of the evidence base supporting this treatment methodology is included in the reference section but it is far from a comprehensive list.