Background and Objective: The use of plant-based products for burn treatment dates back to 1600 BC. Enzymatic debridement, which can be achieved as non-surgical or conservative debridement, has recently gained increasing attention. Several reviews have been published thus far. However, there has been no historical article including the achievements of the last 20 years, and this is the first review to present the achievements made in the field of enzymatic debridement in the last 20 years. This study aimed to present a historical overview of the development of enzymatic debridement until the present day. Methods: Enzymes from bacteria and plants were initially used for full-thickness burn treatment; however, they did not gain attention. Papain-derived products were the first plant-based products used for enzymatic debridement. Sutilains gained broad use in the 70s and 80s but came off market in the 1990s. Bromelain has been used for burn treatment owing to its strong debriding properties. NexoBrid^™ is used as a minimally invasive approach for enzymatic debridement of deep dermal burns. However, its use has been limited due to commercially available bromelain and the presence of four distinct cysteine proteinases. NexoBrid^™ involves faster eschar removal together with reduced blood loss, leading to improved long-term outcomes. However, research on nonoperative enzymatic debridement of burns has taken decades and is still ongoing. Results: Overall, the results of our study indicate that necrectomy, which has been used for a long time, remains the standard of care for burns. However, enzymatic debridement has several advantages, such as faster eschar removal, reduced blood loss, and reduced need for skin grafting, especially in cases of facial and hand burns. Enzymatic debridement cannot replace surgical intervention, as the enzyme only works on the surface of the eschar. Enzymatic debridement is not recommended in the early phase of scald burns. Conclusions: Enzymatic debridement has become an integral part of burn therapy and the standard of care in specific burn centers.

Following the enzymatic debridement of deep dermal burns, the choice of wound dressing is crucial for providing an adequate environment and suitable conditions for rapid wound healing. As Suprathel^® and fatty gauze (Jelonet^®) are the most commonly used dressings in burn centers, the aim of this study is to compare Suprathel^® and Jelonet^® in the treatment of deep dermal burns after enzymatic debridement with respect to wound healing, patient comfort, and pain. A total of 23 patients with deep dermal burns of the hand or foot (mean total body surface area of 4.31%) were included in this prospective, unicentric, open, comparative, and intra-individual clinical study. After enzymatic debridement, wounds were divided into two areas: one was treated with Suprathel^® and the other with Jelonet^®. Suprathel^® remained on the wounds without dressing changes while Jelonet^® was regularly changed. Wound healing, infection, bleeding, exudation, time for dressing changes, and pain were documented (from days 2 to 48) after injury. Satisfactory results were obtained in 22 cases; only one patient had to undergo a second debridement followed by skin grafting. No significant difference in time to final wound healing could be observed (18–19 d). Patients reported significantly less pain during the dressing changes for Suprathel^® compared to Jelonet^®. Furthermore, the wound areas treated with Suprathel^® showed significantly less exudation and bleeding. Wound infections rarely occurred in both groups. In conclusion, the authors found that both wound dressings could be used to achieve safe and rapid wound healing after the enzymatic debridement of deep dermal burns of the hands and feet. However, compared to Jelonet^®, Suprathel^® showed superior results in terms of patient comfort and pain reduction.

Background and Objectives: Burn surgery on the hands is a difficult procedure due to the complex anatomy and fragility of the area. Enzymatic debridement has been shown to effectively remove burn eschar while minimizing damage to the surrounding tissue and has therefore become a standard procedure in many burn centers worldwide over the past decade. However, surprisingly, our recent literature review showed limited valid data on the long-term scarring after the enzymatic debridement of the hands. Therefore, we decided to present our study on this topic to fill this gap. Materials and Methods: This study analyzed partial-thickness to deep dermal burns on the hands that had undergone enzymatic debridement at least 12 months prior. Objective measures, like flexibility, trans-epidermal water loss, erythema, pigmentation, and microcirculation, were recorded and compared intraindividually to the uninjured skin in the same area of the other hand to assess the regenerative potential of the skin after EDNX. The subjective scar quality was evaluated using the patient and observer scar assessment scale (POSAS), the Vancouver Scar Scale (VSS), and the “Disabilities of the Arm, Shoulder, and Hand” (DASH) questionnaire and compared interindividually to a control group of 15 patients who had received traditional surgical debridement for hand burns of the same depth. Results: Between January 2014 and December 2015, 31 hand burns in 28 male and 3 female patients were treated with enzymatic debridement. After 12 months, the treated wounds showed no significant differences compared to the untreated skin in terms of flexibility, trans-epidermal water loss, pigmentation, and skin surface. However, the treated wounds still exhibited significantly increased blood circulation and erythema compared to the untreated areas. In comparison to the control group who received traditional surgical debridement, scarring was rated as significantly superior. Conclusions: In summary, it can be concluded that the objective skin quality following enzymatic debridement is comparable to that of healthy skin after 12 months and subjectively fares better than that after tangential excision. This confirms the superiority of enzymatic debridement in the treatment of deep dermal burns of the hand and solidifies its position as the gold standard.

The infraorbital region is challenging to treat due to complex anatomy and issues like skin laxity, malar edema, and malar mounds. This study evaluates micro focused ultrasound with visualization (MFU-V) as a non-invasive treatment for infraorbital rejuvenation, hypothesizing improved skin tightening and contouring. A case series with anatomical analysis and literature review. Five female patients (aged 42–54) with mild-to-moderate skin laxity underwent MFU-V treatment using 1.5, 3.0, and 4.5 mm transducers. Standardized photos and assessment scales (Merz Infraorbital Hollow Scale, GAIS) were used at baseline and 6 months. MFU-V led to visible improvements in periorbital skin tightening and reduction of malar mounds, especially in more pronounced cases. No adverse effects occurred. MFU-V is a safe, effective, and non-invasive option for periorbital rejuvenation. It may serve as an alternative to surgical treatment for infraorbital skin laxity and malar deformities. Larger studies are needed to confirm efficacy. The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki. All patients provided written informed consent. ^‡ These authors contributed equally to this article. Article published online: 05 August 2025 © 2025. Thieme. All rights reserved. Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

Introduction: Superficial partial thickness burns generally do not require surgical intervention and are managed with specialized wound dressings. Mepilex Ag^® is commonly used and often represents the standard of care. This study evaluated the clinical performance of pure silk compared to Mepilex Ag^®. Methods: A prospective, single-center intraindividual study was conducted on adult patients with superficial partial thickness burns. Each burn wound was divided, treating one half with pure silk and the other with Mepilex Ag^®. Clinical parameters including wound closure time, pain levels, and scar quality at 3-month follow-up were analyzed. Results: Twenty-four patients were included (mean TBSA: 5.8%). Mepilex Ag^® showed a trend towards a shorter wound closure time (10.5 vs. 11.5 days; p = 0.223). Pain scores remained below 4/10 for both dressings throughout treatment. However, Mepilex Ag^® demonstrated significantly lower pain on day one (3.5 vs. 2.77; p = 0.039) and day two (2.91 vs. 2.27; p = 0.041). Scar quality after 3 months was similar. Conclusion: Both dressings proved to be effective treatment options. Pure silk required fewer resources, showed high clinical practicality, and demonstrated a similar performance to Mepilex Ag^® in key clinical parameters, making it an interesting option for other clinics and our standard of care.