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In contrast to tangential excision, enzymatic debridement with NexoBrid® selectively removes non-viable tissue, allowing some deep dermal burn woundsto still heal conservatively. In thisretrospective study, we investigated the reduction in surgery and associated scarring following enzymatic debridement in definitely deep burns as proven by laser Doppler imaging. One hundred two exclusively laser Dopplerimaging-blue regions of interest where there was no doubt at all about the surgical indication, were selected for analysis in 32 patients treated with NexoBrid®. The total surface area of the 102 exclusively blue regions of interest was 5,086.4cm². NexoBrid® resulted in a substantial reduction in the need for autografts as 1,986.9cm² (39%) healed with conservative treatment. This corresponded with a significant reduction in patients(56.3%) requiring surgery. Exclusively laser Doppler imaging-blue regions of interest treated surgically with split thickness skin grafts required significantly more time to heal compared to conservative treatment (37.8±17.5 vs. 27.0±10.5 days). Avery limited rate of hypertrophic scarring (16.7%) was observed. Thisisthe first paper demonstrating a proven and significant reduction in the extent of autografting as well asin the number of surgical procedures afterselective enzymatic debridement in objectively laser Doppler imaging-defined and therefore proven deep burns. Even after extended conservative treatment with prolonged healing timesfollowing NexoBrid®, hypertrophic scar formation waslimited (5/54 regions of interest, 9.3%). Also in operated patients, the incidence of hypertrophic scarring following a strict regimen of aftercare was low (12/48 regions of interest, 25%). [ABSTRACT FROM AUTHOR]