Proteolytic Enzymes and Wound Debridement: A Literature Review

BACKGROUND: Wound debridement is crucial for effective wound management and essential for removing necrotic tissue, reducing bacterial load, and encouraging granulation. While surgical debridement is prevalent, it can be traumatic and can potentially delay healing by enlarging the wound area. OBJECTIVE: To summarize the existing literature on the role of proteolytic enzymes in wound debridement, with a focus on their applications, benefits, limitations, and future potential in wound care management. METHODS: A systematic search was conducted in PubMed (National Library of Medicine) and Google Scholar, reviewing English-language publications from 1974 to 2023. Keywords included "enzymatic debridement", "wound healing", "collagenase", "bromelain", "proteolytic enzymes", and "debridement". RESULTS: Enzymatic debridement has emerged as a promising, less invasive alternative to surgical debridement. Bromelain, which targets heat-denatured proteins, shortens healing times and improves scar quality. Collagenase and papain have been widely used globally, highlighting their efficacy in various wound types, although concerns have been noted about papain's safety. Preliminary studies on enzymes such as chymotrypsin, aurase, actinidin, Antarctic krill (Euphausia superba) enzymes, and dispase also show encouraging results. A limited number of studies comparing various debriding enzymes in the literature were identified, revealing significant differences between them, highlighting the need for additional comparative research studies. CONCLUSIONS: The advantages of enzymatic debridement over surgical debridement, particularly in nontraumatic applications and with enhanced healing times with the former, underscore its potential in clinical settings. Further research is warranted to optimize use of enzymatic debridement and understand the full scope of benefits and limitations of these enzymes in wound management.