The use of strong chemical debriding agents is gaining traction in the early treatment of selected burns.[91]Shoham Y, Krieger Y, Goverman J. Anacaulase-bcdb for the treatment of severe thermal burns. Expert Opin Biol Ther. 2023 Jul-Dec;23(12):1185-91.
http://www.ncbi.nlm.nih.gov/pubmed/37833828?tool=bestpractice.com
[92]Shoham Y, Rosenberg L, Hickerson W, et al. Early enzymatic burn debridement: results of the DETECT multicenter randomized controlled trial. J Burn Care Res. 2024 Mar 4;45(2):297-307.
http://www.ncbi.nlm.nih.gov/pubmed/37715999?tool=bestpractice.com
Pain control during treatment is an important consideration.[93]Claes KEY, Amar S, Hoeksema H, et al. Pain management during a bromelain-based selective enzymatic debridement in paediatric and adult burn patients. Burns. 2022 May;48(3):555-67.
http://www.ncbi.nlm.nih.gov/pubmed/34686390?tool=bestpractice.com
Presently, use should be limited to burn centres.
Autologous epithelial cell suspension
Immediate application of low-density epithelial cell spray has been proposed as an adjunct to healing in selected burn wounds.[94]Kahn SA, Carter JE, Wilde S, et al. Autologous skin cell suspension for full-thickness skin defect reconstruction: current evidence and health economic expectations. Adv Ther. 2024 Mar;41(3):891-900.
https://link.springer.com/article/10.1007/s12325-023-02777-7
http://www.ncbi.nlm.nih.gov/pubmed/38253788?tool=bestpractice.com
[95]Holmes JH. A brief history of RECELL® and its current indications. J Burn Care Res. 2023 Jan 2;44(suppl_1):S48-9.
https://academic.oup.com/jbcr/article/44/Supplement_1/S48/6960745
http://www.ncbi.nlm.nih.gov/pubmed/36567470?tool=bestpractice.com
It can be used alone or in combination with dermal replacements.[96]Larson KW, Austin CL, Thompson SJ. Treatment of a full-thickness burn injury with novosorb biodegradable temporizing matrix and RECELL autologous skin cell suspension: a case series. J Burn Care Res. 2020 Jan 30;41(1):215-9.
https://academic.oup.com/jbcr/article/41/1/215/5642499
http://www.ncbi.nlm.nih.gov/pubmed/31765469?tool=bestpractice.com