Chemicals and Enzymes in Debridement of Thermal Burns

Introduction  At the present time surgical excision of the burn eschar is the most effective means of preparation for skin grafting. However, it is often bloody and may result in shock unless blood replacement is adequate. Various chemicals and enzymes have been suggested for this purpose. These include pyruvic acid,¹ streptokinase and streptodornase,² trypsin,³ and collagenase,^4,5 none of which has proved completely successful. Theoretically, since over 70% of the dermis is composed of collagen, collagenase should be effective. Difficulty in production and the inability to penetrate the eschar, composed of charred keratin, are the two factors limiting its usefulness. It occurred to us that if a compound could be found which would penetrate or destroy this charred keratin of the burn eschar, collagenase would probably prove to be an effective debriding agent. The results of experimental and clinical investigations designed to test the effectiveness of several