## 4 Discussion  
Excision of burn eschar within the first 48 h after burn injury is a key moment in the treatment of partial- or full-thickness burns, thus significantly reducing the rate of bacterial colonization, infections, sepsis, and, of course, length of hospital stay [12]. The need to preserve as much viable tissue as possible has resulted in alternative methods of surgical debridement, especially for areas with complex anatomy, which include muscles, tendons, vessels and well-compacted nerves, and a lack of subcutaneous tissue that would provide additional protection to the hands and face. These structures are at risk of injury during surgical debridement [13]. The need for non-surgical burn debridement resulted in the development of bromelain-based agents. In 1957, [PERSON] and [PERSON] described a new protease from pineapple fruit [14]. In 1971, [PERSON] demonstrated the therapeutic properties of bromelain [15]. [PERSON] proved the efficiency of bromelain in enzymatic debridement using a pig model [16]. Bromelain is a major protease of Ananas Comousis. Bromelain is usually found in the fruit and stem of pineapple, with multiple differences and similarities. Fruit and stem bromelain belong to the group of cysteine proteases (fruit bromelain--BAA21848 and stem bromelain--CAA08861). Bromelain is a defense protein that protects the pineapple fruit during its development [17]. It contains a mixture of proteolytic enzymes and non-enzymatic substances, being used in the treatment of edema, inflammation, burns, and pain. Bromelain preparations are used for non-surgical debridement but require adequate pain treatment [18]. During application, the healthy surrounding skin has to be protected. Early eschar debridement and removal remains the cornerstone of modern burn therapy [19]. [PERSON] et al., who conducted a comparative study between enzymatic debridement (75 burns) and surgical debridement (81 burns), found that mean times to complete debridement were 2.2 \(\pm\) 1.4 days for bromelain and 8.7 \(\pm\) 5.7 days for surgical \begin{table}
\begin{tabular}{l c c} \hline \hline
**Criteria** & **Enzymatic Debridement** & **Surgical Debridement** \\ \hline Pigmentation & & \\
0 (normal color) & 0 & 0 \\
1 (hypopignentation) & 4 & 5 \\
2 (hyperpigmentation) & 11 & 10 \\ Vascularity & 0 (normal) & 0 \\
1 (pink) & 6 & 7 \\
2 (red) & 8 & 7 \\
3 (purple) & 1 & 1 \\ Pliability & & \\
0 (normal) & 0 & 0 \\
1 (supple) & 7 & 11 \\
2 (yielding) & 5 & 1 \\
3 (firm) & 1 & 2 \\
4 (banding) & 2 & 1 \\
5 (contracture) & 0 & 0 \\ Height & & \\
0 (normal flat) & 9 & 8 \\
1 (<2) & 4 & 4 \\
2 (>2 and <5) & 2 & 3 \\
3 (>5) & 0 & 0 \\ \hline \hline \end{tabular}
\end{table} 
Table 3: Vancouver Scar Scale. debridement [20]. Similar results have been reported by [PERSON] et al. in 20 patients with hand burns [21]. These results are significant because the prolonged time to complete eschar debridement and failure to completely remove the eschar could lead to hypertrophic scarring. Our study highlights the characteristics, differences, and needs of enzymatic debridement in burn lesions. The need for proper pain management, the efficient use of bromelain, and the resulting shortening of burn debridement time have been emphasized. It was possible to assess the correctness of the preprocessed burn lesion depth assessment as well as the time and characteristics of healing and post-healing rehabilitation. Our study also highlights the higher aesthetic quality of the post-burn scars treated with enzymatic debridement compared to those treated with surgical excision, according to the values obtained from the Vacouver Scar Scale. Since 2012, NexoBrid(tm) has been approved as a minimally invasive treatment [14]. The instructions for bromelain use recommend for it to be applied to less than 15% TBSA in one session. At the 2017 European Consensus, it was agreed that burns up to 30% TBSA and those exceeding 72 h of management can be enzymatically debrided in a single session, but this is currently off-label use [22].