Effect of enzymatic debridement with two different collagenases versus mechanical debridement on chronic hard‐to‐heal wounds

Abstract

A chronic ulcer is usually defined as an injury that does not spontaneously evolve towards healing and does not progress through normal healing stages such as inflammation, proliferation and remodelling. This study was designed in order to compare two types of collagenases with mechanical debridement alone. It was thus possible to evaluate their differences in terms of pain and debridement efficacy. Patients were divided into three groups: 30 patients were daily dressed using an ointment based on collagenase produced by Vibrio alginolyticus (B group), 30 patients were daily dressed using an ointment based on a collagenase preparation derived from Clostridium histolyticum (N group) and 30 patients underwent classical mechanical debridement (M group). Complete wound healing over a period of 8 weeks occurred in 24 patients (27%) out of 90;10 patients belonging to the B group, 8 patients to the N group and 6 patients to the M group. This study was performed in order to highlight the differences between two commercially available collagenase-based ointments in comparison with mechanical debridement alone. At the final time point of week, the difference in the percentage of debridement was not statistically significant in all groups, but at 4 weeks, the debrided area in the B group was larger with respect to the N and M groups, suggesting a more rapid wound bed cleansing process. On the basis of our experience, collagenase derived from V. alginolyticus with hyaluronic acid showed chemical and physical properties that make it a product of great manageability and ensure the protection of peri-wound skin. Moreover, less pain was experienced by the patients.

An Alternative Treatment Strategy for Complicated Chronic Wounds: Negative Pressure Therapy over Mesh Skin Graft

“…Numerous studies have been carried out on the combined use of NPWT over dermal substitutes also to cover large and deep wounds (including bone and tendon exposure) [7–13]. Every study assessed that, thanks to the integrated use of these techniques, the preparation of the wound bed was quicker in order to obtain a better graft take [14]. In fact NPWT used over the dermal template delivered a faster maturation (approximately 1-2 weeks) and a higher integration quality [15, 16].…”

Efficiency of Enzymatic Debridement in the Healing Process of Chronic Wounds in Small Animal Practice

“…Further research into the efficacy of enzymatic debridement in small animal practice should include a comparison with different methods of debridement used in similar wounds, as carried out in human patients by O n e s t i et al [6]. Further research should also include histological analysis of the wound before and after enzymatic debridement.…”

“…Both studies found the treatment to be well-tolerated by patients and even to reduce pain at the wound site. Another human study by O n e s t i et al [6] compared the efficacy of enzymatic and mechanical debridement and showed that cases treated with enzymatic debridement had more rapid reduction in wound size and caused less pain than debridement using wet-to-dry dressings.…”

“…It involves the direct application of proteolytic enzymes to a wound, which breaks down necrotic tissue. There have been only a few studies on the efficacy of enzymatic debridement in animal patients, however it has been used very successfully in human patients [5,6]. Collagenase-based preparations are the most common type of enzymatic debriding agents.…”

“…Studies in human medicine have shown that the use of collagenase increases the speed of healing and reduction in wound size, as well as reducing inflammation [6,8].…”