Nexobrid Use in the Elderly

Background: Nexobrid (NXB) is a pineapple-derived enzymatic debridement product approved for patients aged 18 to 65. This study evaluated its off-label use in an elderly population with severe burns. Methods: This was a case-series study involving 43 patients aged 66-94 years who had deep-partial and full-thickness burns treated with NXB. We assessed patient demographics, burn characteristics, treatment outcomes, and complications. Results: The most common cause of burns was flame. The median total burned surface area (TBSA) was 11%, and the median NXB-treated area was 7.41%. Most patients (76.74%) required surgery following debridement. The median hospital stay was 26.5 days, and the median time to healing was 63 days. The rates for mortality, infections, and transfusion requirements were 25.58% each. Nine patients developed hypertrophic scarring. Conclusions: NXB is a useful tool for debriding burns on the hands, face, and limbs in the elderly, offering a less aggressive alternative to surgical debridement. However, a significant proportion of these patients still need surgery to close their wounds and may develop hypertrophic scars. Therefore, a careful risk-benefit assessment is necessary before its application in this patient group.