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Italian recommendations on enzymatic debridement in burn surgery.

  • Ranno, Rosario1
  • Vestita, Michelangelo2
  • Maggio, Giulio3
  • Verrienti, Pasquale4
  • Melandri, Davide5
  • Orlandi, Catuscia5
  • Perniciaro, Giuseppe6
  • De Angelis, Armando7
  • D'Alessio, Roberto8
  • Mataro, Ilaria8
  • Pagnozzi, Eliana8
  • Alessandro, Giovanni9
  • Caleffi, Edoardo10
  • Di Lonardo, Antonio11
  • Ciappi, Serena11
  • Palombo, Paolo12
  • Posadinu, Maria Alma13
  • Stella, Maurizio14
  • Romeo, Mariarosa14
  • Minic, Jasminka15
  • And 2 more
  • 1 Burn Unit, Ospedale Cannizzaro, Catania, Italy. , (Italy)
  • 2 Division of Plastic and Reconstructive Surgery and Burn Unit, University of Bari, Bari, Italy. Electronic address: [email protected] , (Italy)
  • 3 Division of Plastic and Reconstructive Surgery and Burn Unit, University of Bari, Bari, Italy. , (Italy)
  • 4 Burn Unit, Ospedale Perrino, Brindisi, Italy. , (Italy)
  • 5 Burn Unit, Ospedale M. Bufalini, Cesena, Italy. , (Italy)
  • 6 Burn Unit, Ospedale Villa Scassi, Genova, Italy. , (Italy)
  • 7 Burn Unit, A.O. Niguarda Ca' Granda, Milano, Italy. , (Italy)
  • 8 Burn Unit, Ospedale Cardarelli, Napoli, Italy. , (Italy)
  • 9 Burn Unit, Ospedale Civico Fatebenefratelli, Palermo, Italy. , (Italy)
  • 10 Burn Unit, Ospedale Maggiore Az. Osp., Parma, Italy. , (Italy)
  • 11 Burn Unit, Ospedale Cisanello, Pisa, Italy. , (Italy)
  • 12 Burn Unit, Ospedale Sant Eugenio Di Roma, Roma, Italy. , (Italy)
  • 13 Burn Unit, Ospedale Civile, Sassari, Italy. , (Italy)
  • 14 Burn Unit, Ospedale CTO Torino, Torino, Italy. , (Italy)
  • 15 Burn Unit, Ospedale Civile Maggiore, Verona, Italy. , (Italy)
Published Article
Burns : journal of the International Society for Burn Injuries
Publication Date
Mar 01, 2021
DOI: 10.1016/j.burns.2020.07.006
PMID: 32723513


Nexobrid®, a bromelain-based type of enzymatic debridement, has become more prevalent in recent years. We present the recommendations on enzymatic debridement (Nexobrid®)'s role based on the practice knowledge of expert Italian users. The Italian recommendations, endorsed by SIUST (Italian Society of Burn Surgery), on using enzymatic debridement to remove eschars for burn treatment were defined. The definition followed a process to evaluate the level of agreement (a measure of consensus) among selected experts, representing Italian burn centers, concerning defined clinical aspects of enzymatic debridement. The consensus involved a multi-phase process based on the Delphi method. The consensus panel included experts from Italy with a combined experience of 1068 burn patients treated with enzymatic debridement. At the end of round 3 of the Delphi method, the panel reached 100% consensus on 26 out of 27 statements. The panel achieved full, strong consensus (all respondents strongly agreed on the statement) on 24 out of 27 statements. The statements provided by the Italian consensus panel represent a "ready to use" set of recommendations for enzymatic debridement in burn surgery that both draw from and complete the existing scientific literature on the topic. These recommendations are specific to the Italian experience and are neither static nor definitive. As such, they will be updated periodically as further quality evidence becomes available. Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.

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