Equine Pericardium Collagen Wound Dressing in the Treatment of the Neuropathic Diabetic Foot Wound

Fleischli, John G.; Laughlin, Terese J.; Fleischli, Jeffery W.

doi:10.7547/0980301

Cited by 18 publications

(14 citation statements)

References 21 publications

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“…Other xenograft collagen dressings have been reported in the literature. Fleischli and colleagues33 studied equine pericardium applied to 23 patients with 34 DFUs present for at least 4 weeks. Following debridement, the graft was sutured in place and a below-knee compression wrap (with antibiotic ointment) was applied, and a cast boot or sandal was used for offloading.…”

Section: Discussionmentioning

confidence: 99%

Collagen-based wound dressings for the treatment of diabetes-related foot ulcers: a systematic review

Holmes¹,

Wrobel²,

MacEachern³

et al. 2013

DMSO

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BackgroundDiabetic foot ulcers are a major source of morbidity, limb loss, and mortality. A prolonged inflammatory response, extracellular matrix degradation irregularities, and increased bacteria presence have all been hypothesized as major contributing factors in the delayed healing of diabetic wounds. Collagen components such as fibroblast and keratinocytes are fundamental to the process of wound healing and skin formation. Wound dressings that contain collagen products create a biological scaffold matrix that supports the regulation of extracellular components and promotes wound healing.MethodsA systematic review of studies reporting collagen wound dressings used in the treatment of Diabetic foot ulcers was conducted. Comprehensive searches were run in Ovid MEDLINE, PubMed, EMBASE, and ISI Web of Science to capture citations pertaining to the use of collagen wound dressings in the treatment of diabetic foot ulcers. The searches were limited to human studies reported in English.ResultsUsing our search strategy, 26 papers were discussed, and included 13 randomized designs, twelve prospective cohorts, and one retrospective cohort, representing 2386 patients with diabetic foot ulcers. Our design was not a formal meta-analysis. In those studies where complete epithelialization, 58% of collagen-treated wounds completely healed (weighted mean 67%). Only 23% of studies reported control group healing with 29% healing (weighted mean 11%) described for controls.ConclusionCollagen-based wound dressings can be an effective tool in the healing of diabetic foot wounds. The current studies show an overall increase in healing rates despite limitations in study designs. This study suggests that future works focus on biofilms and extracellular regulation, and include high risk patients.

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Section: Discussionmentioning

confidence: 99%

Collagen-based wound dressings for the treatment of diabetes-related foot ulcers: a systematic review

Holmes¹,

Wrobel²,

MacEachern³

et al. 2013

DMSO

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“…222,223 Currently available nonhuman ECM products with clinical data to support their efficacy include porcine-derived small intestinal submucosa, porcine urinary bladder matrix, bovine dermis, equine pericardium, and sheep (ovine) bladder. [224][225][226][227][228][229][230][231][232][233] Another matrix dressing (Hyalomatrix Ò ; Anika Therapeutics, Inc., Bedford, MA) comprising primarily hyaluronan, one of the main constituents of ECM, has also been studied in Europe as a dermal substitute for use in burns, VLUs, and DFUs. [234][235][236][237] Integra Ò bilayer wound matrix (Integra LifeSciences, Plainsboro, NJ) is a dermal regeneration template in this category (bovine collagen, glycosaminoglycans, and silicone layer) that has primarily been used in burns for a number of years, but is being more frequently used in lower extremity chronic wounds and foot ulcers.…”

Section: Biological and Bioengineered Therapiesmentioning

confidence: 99%

Challenges in the Treatment of Chronic Wounds

Frykberg

Banks

2015

Advances in Wound Care

1,811

1,429

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Significance: Chronic wounds include, but are not limited, to diabetic foot ulcers, venous leg ulcers, and pressure ulcers. They are a challenge to wound care professionals and consume a great deal of healthcare resources around the globe. This review discusses the pathophysiology of complex chronic wounds and the means and modalities currently available to achieve healing in such patients.Recent Advances: Although often difficult to treat, an understanding of the underlying pathophysiology and specific attention toward managing these perturbations can often lead to successful healing.Critical Issues: Overcoming the factors that contribute to delayed healing are key components of a comprehensive approach to wound care and present the primary challenges to the treatment of chronic wounds. When wounds fail to achieve sufficient healing after 4 weeks of standard care, reassessment of underlying pathology and consideration of the need for advanced therapeutic agents should be undertaken. However, selection of an appropriate therapy is often not evidence based.Future Directions: Basic tenets of care need to be routinely followed, and a systematic evaluation of patients and their wounds will also facilitate appropriate care. Underlying pathologies, which result in the failure of these wounds to heal, differ among various types of chronic wounds. A better understanding of the differences between various types of chronic wounds at the molecular and cellular levels should improve our treatment approaches, leading to better healing rates, and facilitate the development of new more effective therapies. More evidence for the efficacy of current and future advanced wound therapies is required for their appropriate use.

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“…Collagen scaffolds have also been shown to effectively accelerate wound healing in chronic nonhealing wounds [Wu et al, 2003;Worley, 2005;Fleischli et al, 2009;Abou Neel et al, 2013]. Despite these successes, in many cases engineered ECM scaffolds typically do not elicit the constructive and functional remodeling response observed with scaffolds composed of intact ECM as these materials lack the complex ultrastructure and composition of an intact ECM scaffold.…”

Section: Discussionmentioning

confidence: 99%

Human NELL1 Protein Augments Constructive Tissue Remodeling with Biologic Scaffolds

Turner

Londoño²,

Dearth³

et al. 2013

Cells Tissues Organs

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Biologic scaffolds composed of extracellular matrix (ECM) derived from decellularized tissues effectively reprogram key stages of the mammalian response to injury, altering the wound microenvironment from one that promotes scar tissue formation to one that stimulates constructive and functional tissue remodeling. In contrast, engineered scaffolds, composed of purified ECM components such as collagen, lack the complex ultrastructure and composition of intact ECM and may promote wound healing but lack factors that facilitate constructive and functional tissue remodeling. The objective of the present study was to test the hypothesis that addition of NELL1, a signaling protein that controls cell growth and differentiation, enhances the constructive tissue remodeling of a purified collagen scaffold. An abdominal wall defect model in the rat of 1.5-cm² partial thickness was used to compare the constructive remodeling of a bovine type I collagen scaffold to a biologic scaffold derived from small intestinal submucosa (SIS)-ECM with and without augmentation with 17 μg NELL1 protein. Samples were evaluated histologically at 14 days and 4 months. The contractile response of the defect site was also evaluated at 4 months. Addition of NELL1 protein improved the constructive remodeling of collagen scaffolds but not SIS-ECM scaffolds. Results showed an increase in the contractile force of the remodeled skeletal muscle and a fast:slow muscle composition similar to native tissue in the collagen-treated group. The already robust remodeling response to SIS-ECM was not enhanced by NELL1 at the dose tested. These findings suggest that NELL1 protein does contribute to the enhanced constructive remodeling of skeletal muscle.

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Equine Pericardium Collagen Wound Dressing in the Treatment of the Neuropathic Diabetic Foot Wound

Abstract: This first report of equine pericardium used to treat neuropathic foot ulcerations demonstrates that the equine pericardium dressing is a safe and beneficial treatment for neuropathic wounds.

Cited by 18 publications

References 21 publications

Collagen-based wound dressings for the treatment of diabetes-related foot ulcers: a systematic review

Collagen-based wound dressings for the treatment of diabetes-related foot ulcers: a systematic review

Challenges in the Treatment of Chronic Wounds

Human NELL1 Protein Augments Constructive Tissue Remodeling with Biologic Scaffolds

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