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These are wounds that can remain open for months and even years, cause severe pain, recurring infections, severe damage to quality of life, and sometimes even lead to limb amputations and mortality.

MediWound, which employs about 120 workers in Israel and around the world, has in recent years become a familiar name in the field of burn medicine thanks to NexoBrid, a drug based on enzymes extracted from pineapple stems. The treatment allows for selective removal of dead and damaged tissue, without damaging the healthy tissue surrounding it.

"There are about 10% of the wounded who suffered from significant burns," he says. "In many cases we managed to save surgeries and improve the medical and aesthetic result."

The experience gained during the war also attracted attention outside Israel. About a month ago, the company signed a strategic agreement valued at about $200 million with the United States government, under which the US will procure a strategic stock of the drug for emergency cases and mass casualty events.

"When there is a mass casualty event with hundreds of wounded, it is impossible to bring everyone into operating rooms," explains Gonen. "The drug allows fast and efficient treatment even under complex conditions."

Now the company seeks to apply the same therapeutic approach in a completely different field.

According to estimates, more than four million people in the United States suffer from chronic wounds. In Israel, it involves thousands of patients.

"These wounds accompany people for months and sometimes years," says Gonen. "They are painful, emit an unpleasant odor, limit functioning, and severely impair the quality of life."

EscharEx is based on the same enzymatic technology, but is tailored specifically to the needs of chronic wounds.

"We remove all non-viable tissue that prevents the wound from healing," explains Gonen. "In burns you want to act fast and more aggressively. In a chronic wound, the goal is to be gentle, reduce side effects, and allow the patient to continue their daily routine."

According to him, the treatment is time-limited and is not intended for prolonged use. "It involves a series of up to eight treatments over a period of a week to two weeks. The goal is to prepare the wound for healing and closure."

The study has already begun operating in Israel. At this stage, the Sheba, Kaplan, Shamir, and Beilinson medical centers are participating, and an additional medical center is expected to join later.

"We hope to complete the recruitment of all 216 patients by the end of the first quarter of 2027," says Gonen. "A few dozen of them will be from Israel."

According to him, the main idea of the treatment is to allow the wound to return to an active healing process. "A chronic wound is essentially a wound that got stuck," explains Prof. Haik. "We clean it very precisely and remove only the damaged tissue. By doing so, we give it a new opportunity to restart the recovery process."

According to Prof. Haik, this is a critical stage before any other advanced treatment. "It doesn't matter if you use special dressings, hyperbaric chambers, or other technologies. First of all, you need a clean wound."

Haik admits that when the technology was first presented two decades ago, many in the medical community treated it with skepticism. "We were very skeptical about this drug," he says. "But today we know that the treatment saved about 60% of the burn surgeries we used to perform in the past."

According to him, the experience gained in burns provides a strong scientific and medical basis for expanding its use to the field of chronic wounds as well. "If surgery can be avoided through topical treatment and achieve a similar or even better result, it is a dramatic change. This technology has already changed the way burns are treated once. Now we are testing whether it can do the same thing for patients who have been living for years with non-healing wounds."

Chronic wounds are considered one of the most expensive and complex problems in healthcare systems around the world. They require frequent clinic visits, prolonged treatments, and sometimes recurrent hospitalizations.

According to Prof. Haik, every wound is a world of its own. "I have more than 30 years of experience in the field, and I can say that no two wounds are identical. Every patient brings a different medical background and different challenges."

He explains that currently, wound debridement options are relatively limited and mainly include surgical intervention, chemical agents, and other methods. "Surgery is an important tool, but it is not always the right solution. Especially in elderly or complex patients. Here there is an option to clean the wound very precisely, without damaging healthy tissue."

If the current study succeeds, it is possible that the Israeli technology that has already brought about one revolution in the field of burns will manage to do so again, this time for millions of people around the world living with non-healing wounds that affect their quality of life daily.