When to Consider Using Enzymatic Debridement vs Sharp Debridement

In this video interview, Dr. John C. Lantis II describes when a practitioner may want to consider using a bromelain-based enzymatic debriding agent over sharp debridement. At SAWC Spring 2023, Dr. Lantis presented the findings of a study (Results from a Phase 2 multicenter, randomized, placebo controlled, adaptive design study performed to evaluate safety and efficacy of Bromelain-based enzymatic debridement agent in debridement of Venous Leg Ulcers) in which the debriding agent was assessed for complete debridement.
 

Transcript:

Hello, I'm John Lantis. I'm a vascular surgeon in New York City who's been involved in prospective randomized trials in the wound care field and wound healing and closure for the last 23 years.

Well, it's interesting to think about how we currently use enzymatic debridement, which we do have available to us for chronic wounds and is a gentle and very safe therapy that we've used for many years. However, I think we're going to have a paradigm shift with this new product. The bromelain-based product is a very rapid debriding agent and not so much changes the thought of when should I use enzymes, but it changes the thought of, should I be using enzyme versus sharp debridement? Or maybe with sharp debridement, but it really is something that would be more likely to replace sharp debridement.

So I think the place that we should be thinking about using enzymes or the type of patient would be the patient who is going to have difficulty with sharp debridement, such as patients with atypical ulcers, which often have significant pain, or venous leg ulcers. Ulcers like sickle cell disease may be able to be debrided with this agent, or even possibly pyoderma gangrenosum. Things that we shy away from sharp debridement at the moment.

So I think there's a lot of questions to be answered yet probably, certainly more than have already been answered about this bromelain-based product. But I think it will allow for more rapid debridement for a wider spectrum of patients than we currently provide any debridement for, whether enzymatic, autolytic, or sharp.