Background: Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe, potentially life-threatening mucocutaneous reactions classified based on body surface area (BSA) involvement: SJS affects less than 10% BSA, SJS/TEN overlap affects 10–30% BSA, and TEN affects more than 30% BSA. The mortality rates range from 4.8–9% for SJS to 14.8–48% for TEN. Treatment remains controversial, with corticosteroids and intravenous immunoglobulin (IVIg) being the most debated therapeutic options. While some studies suggest IVIg may block Fas-mediated keratinocyte apoptosis, meta-analyses have shown conflicting results regarding mortality benefit. Case presentation: We describe two patients from opposite ends of the SJS/TEN spectrum, managed in a burn unit with different therapeutic approaches. The first patient, a 47-year-old man with systemic lupus erythematosus, developed TEN with approximately 35% body surface area involvement, complicated by sepsis and rhabdomyolysis; he was treated with systemic corticosteroids and intravenous immunoglobulin (IVIg, 0.4 g/kg/day for 3 days). The second patient, a 66-year-old woman, developed SJS attributed to amoxicillin–clavulanic acid and was treated with systemic corticosteroids alone. Both patients achieved complete re-epithelialization without major sequelae. Conclusions: These two cases illustrate the clinical heterogeneity of the SJS/TEN spectrum and the central role of early recognition, prompt withdrawal of the culprit drug, transfer to a specialized unit, and multidisciplinary supportive care. Given the substantial differences between the two patients in age, sex, comorbidities, culprit drugs, and disease severity, no comparative or causal inference regarding the relative efficacy of the two treatment strategies can be drawn; no efficacy claim is made for either therapeutic approach; this report is descriptive, and the two cases are presented as contrasting rather than comparable.

Background: The Meek micrografting technique remains an important option in burn reconstruction, particularly when donor sites are limited. By expanding a small split-thickness skin graft into a regularly spaced micrograft array, the method can achieve expansion ratios well beyond those of conventional meshed grafting. This systematic review aims to synthesize the clinical evidence on the Meek technique, its technical evolution since 1958, and its performance relative to mesh grafting across the full spectrum of burn severity. Methods: A systematic review of the surgical literature was conducted according to PRISMA 2020 recommendations. Searches were performed in PubMed, Scopus, and Web of Science from 1958 to 2026, using combinations of the terms Meek technique, Meek micrografting, microdermagrafting, burns, wound coverage, and skin graft expansion. Eligible studies included clinical outcome reports, comparative analyses with mesh grafting, randomized controlled trials, and technical modifications of the Meek method. Results: The search yielded 412 records, of which 15 unique publications met inclusion criteria and were synthesized, including a 2025 intra-patient randomized controlled trial conducted in a mixed wound population. Reports documented the evolution of the Meek technique from its original description in 1958 to contemporary refinements, while clinical studies reported expansion ratios of 1:2 to 1:9 and variable graft-take estimates, often around or above 80% in extensive burns. At the 1:2–1:3 expansion ratios studied, however, the only completed randomized controlled trial found mesh grafting superior to Meek micrografting for graft take and short-term scar quality, indicating that the relative advantage of Meek is most consistent in donor-site-limited injuries requiring high expansion ratios rather than a universal benefit. Conclusions: The Meek technique remains a reproducible and valuable strategy for burn reconstruction when donor sites are critically limited, but current randomized evidence does not support its routine use over mesh grafting within the population and expansion ratios studied, and the available evidence does not establish a universal TBSA threshold for selecting between the two techniques. Future research should prioritize randomized comparisons across a wider range of burn sizes and standardized long-term scar outcome reporting.

Background/Objectives: Bromelain-based enzymatic debridement (NexoBrid^®) is an established tissue-preserving alternative to tangential excision in deep partial-thickness burns. Its clinical efficacy is supported by randomised trials, but its systemic effects are inconsistently described and its effects at tissue level in humans are largely unknown. The objective was to synthesise the human evidence on both domains and to determine, as a prespecified endpoint, whether any study has evaluated them in the same patients. Methods: PubMed, Embase and Scopus were searched between 2016 and 2026 using two stream-specific strategies that shared their intervention and population blocks and differed only in their outcome block: Stream A, clinical outcomes reported with systemic biological parameters; Stream B, clinical outcomes reported with histopathological findings. Eligible studies were original human investigations published in the last ten years. Risk of bias was assessed with ROBINS-I and the JBI checklists, and the synthesis was narrative, following PRISMA 2020 and SWiM. Results: Of 559 records, twelve studies were included: ten in Stream A (970 patients) and two in Stream B (nine patients); no study identified by the present search met the criteria of both. C-reactive protein and procalcitonin were significantly higher after enzymatic than after surgical debridement throughout the first week, and, in the single study that analysed the treated area as a continuous exposure, the probability of a post-debridement coagulation alteration rose with the area treated (odds ratio 1.158 per percentage point of body surface). Early fever occurred in 14% of patients and predicted later wound infection. Both histological studies were purely qualitative: neither reported a thickness, a percentage or a cell count, and neither reported any laboratory value. Conclusions: Enzymatic debridement is associated with a measurable systemic response whose proposed mechanisms are all statements about tissue that has never been examined. The two literature fields describe the same process at two levels of observation, in different patients and at incompatible times. No validated instrument exists for quantifying the human burn biopsy after debridement.

Background/Objectives: Circumferential deep dermal burns generate progressive sub-eschar pressure with risk of burn-induced compartment syndrome (BICS). Bromelain-based enzymatic debridement is a proposed non-surgical decompressive strategy, but the temporal kinetics of intracompartmental pressure (ICP) normalization and their relationship to burn depth are poorly characterized. We explored these kinetics and introduce, as an exploratory descriptive concept, the Enzymatic Decompression Half-Time (EDT₅₀), mapping the ICP normalization curve stratified by Laser Doppler Imaging (LDI) burn depth. Methods: In this single-center retrospective study, 31 adults with circumferential deep dermal burns (IIb, TBSA ≤ 20%) treated with NexoBrid^® were analyzed. ICP was measured at five time points (T0–T24 h) and LDI at T0 and T24 h. Subgroup analyses were treated as descriptive because several subgroups were small. Results: ICP declined progressively with no rebound (repeated-measures ANOVA, p < 0.001). EDT₅₀ appeared depth-dependent (high-flux 2.1 h; low-flux 5.9 h). No patient developed clinical BICS (0/31; 95% CI 0–11%). Pre-treatment LDI flux correlated negatively with ICP (r = −0.71) and EDT₅₀ (r = −0.64). Conclusions: In this small cohort, enzymatic debridement was associated with progressive ICP normalization without clinical compartment syndrome. These hypothesis-generating findings require prospective validation; established BICS remains an absolute indication for surgical escharotomy.