[From the Negev to the Four Corners of the Earth - Enzymatic Debridement of Deep Burns].

Early surgical debridement and skin grafting of deep thermal burns are considered one of the cornerstones of modern burn care. Despite improvement in morbidity and long-term outcomes, the drawbacks of surgery include a non-selective debridement, need for an operating room, blood loss, and donor site scars. The first clinical trial with a pineapple-based concentrate of proteolytic enzymes for enzymatic debridement of deep burns was conducted at Soroka University Medical Center in the last 2 decades of the 20th century. As the treatment is selective, it is intended to reduce the need for surgical debridement and skin-grafting, as it spares viable tissue that may have the potential for spontaneous healing. Years later, after the completion of seven clinical trials, NexoBrid enzymatic debridement received its first approval for use by the European Medicines Agency in 2012. Since then, additional clinical trials including two multicenter RCT's were conducted around the world and the treatment is now approved for use in more than 40 countries worldwide. To date more than 14,000 patients have been treated with NexoBrid and more than 150 papers were published since the first clinical trial. We conducted a Pubmed and Google Scholar search for papers including the terms "NexoBrid" or "Bromelain enzymatic debridement" published between 18/12/2012 (European approval) and 1/3/2025, in which 146 relevant papers were found. This article summarizes the main lessons learned from these papers.