Enzymatic debridement of burn wounds

Principles for the use of exogenous enzymes as debriding agents for burn wounds are briefly discussed. These agents may be utilized in an attempt to accelerate the removal of devitalized tissue from the wound, and this action will hopefully promote wound closure. Past experience has demonstrated that partial thickness burn wounds which close quickly heal with less hypertrophic scar than wounds which close more slowly. Since 75 percent of the dry weight of skin is composed of collagen, exogenous collagenase preparations may prove useful for the debridement of burn wounds. We describe a recent clinical study of the use of a collagenase derived from the bacterium Clostridium histolylicum. Seventy-six patients were studied at seven different United States burn centers. Paired partial-thickness wounds in each patient were treated with silver sulfadiazine or Santyl Collagenase(R) (Knell Pharmaceutical, Whippany, NJ). The use of Santyl Collagenase resulted in more rapid removal of debris from the wound surface and more rapid epithelialization of the wounds, compared to silver sulfadiazine, with statistical significance achieved for both end points (p < 0.001). In addition, wounds treated with Santyl Collagenase were not found to produce more discomfort than wounds treated with silver sulfadiazine, and infection incidences were not different. Continued study of enzymatic debriding agents for burn wounds will hopefully delineate techniques which will encourage wound closure while simultaneously decreasing the intensity and expense of burn wound care.