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

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.