Efficacy and Safety of Bromelain-Based Enzymatic Debridement for Chronic Wounds: A Systematic Review and Meta-Analysis of Randomised Controlled Trials


Gunay U. B., Tanin M. K., DEMİRÖZ USLU A.

WOUND REPAIR AND REGENERATION, vol.34, no.1, 2026 (SCI-Expanded, Scopus) identifier identifier identifier

  • Publication Type: Article / Review
  • Volume: 34 Issue: 1
  • Publication Date: 2026
  • Doi Number: 10.1111/wrr.70132
  • Journal Name: WOUND REPAIR AND REGENERATION
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, CINAHL, EMBASE, MEDLINE
  • Istanbul University Affiliated: No

Abstract

Bromelain-based enzymatic debridement (BBD) may selectively remove devitalised tissue in chronic wounds, but randomised evidence is limited. Following PRISMA and a PROSPERO-registered protocol (CRD420251116455), we searched MEDLINE, CENTRAL and Embase from inception to 8 Aug 2025 for randomised controlled trials in adults with chronic wounds comparing topical BBD versus standard care/vehicle. Two reviewers screened, extracted and assessed risk of bias. Primary outcomes were incidence of complete debridement (efficacy) and >= 1 adverse event (safety). Of 24 records, 3 RCTs (n = 314) met inclusion; 2 contributed complete-debridement data and 3 contributed adverse-event data. BBD increased complete debridement versus control (RR 2.81, 95% CI 1.15-6.86; I-2 = 58.7). Safety was comparable (RR 1.02, 95% CI 0.76-1.36; I-2 = 0), and leave-one-out analyses for adverse events showed no influential study. BBD improves the likelihood of complete debridement without increasing adverse events, suggesting a possible role in its use as a selective, non-surgical adjunct alongside guideline-directed care.