Enzymatic Bromelain-Based Debridement With Nexobrid: A New Treatment to Effectively Prevent Traumatic Tattoos After Abrasive Incidents and Explosive Events

Traumatic tattoos, resulting from the accidental impregnation of foreign particles, are common consequences of road traffic accidents and explosions. Unlike conventional tattoos, these occur when high-impact events embed foreign materials into the skin, causing persistent discoloration and cosmetic disfigurement. Preventing the permanent inclusion of these particles through immediate removal is widely considered as the best strategy. Nowadays, the preventing procedures by means of scrubbing remain insufficient and the need for delayed additional methods is one of the main causes of concern. Consequently, we aim to propose a new therapeutic protocol with enzymatic debridement to prevent and treat traumatic tattoos. In this prospective study, we included patients diagnosed with traumatic tattoos referred to our National Burn Center during 9 months (from June 2024 to March 2025). All were treated with enzymatic debridement (Nexobrid) to remove necrotic tissues after initial cleaning of the wound. Pigmented surface was evaluated before and after enzymatic debridement. A total of 15 consecutive patients were successfully treated with enzymatic debridement (Nexobrid) under sedation within the first 24 hours after the initial incident. In total, 92.5% of the surface of pigmented dermis was cleared from pigments after treatment, thus preventing the occurrence of traumatic tattoos. No adverse events were reported during the treatment. Enzymatic debridement presents a comprehensive approach to wound care in cases of traumatic tattoos, offering precision, tissue preservation, and user-friendly application, and to optimize functional and cosmetic outcomes. These advantages position it as an effective alternative to more traditional methods, particularly in settings that require minimal invasiveness and maximal tissue conservation.