Prospective and randomised evaluation of the protease‐modulating effect of oxidised regenerated cellulose/collagen matrix treatment in pressure sore ulcers

Abstract

In chronic wounds, excess levels and activity of proteases such as elastase and plasmin have been detected. Oxidised regenerated cellulose/collagen matrix (ORC/collagen matrix) has been reported to ameliorate the wound microenvironment by binding and inactivating excess proteases in wound exudates. In this study, the levels and activity of elastase and plasmin in wound exudates of pressure sore ulcers were measured to determine the beneficial effect of ORC/collagen matrix treatment compared with control treatment with a foam dressing. A total of 33 patients with pressure sores were enrolled in the study and were followed up for 12 weeks after treatment. Ten control patients were treated with a foam hydropolymer dressing (TIELLE , Systagenix), and the remaining 23 patients were treated with ORC/collagen matrix plus the foam dressing (TIELLE , Systagenix) on top. Wound assessments were carried out over 12 weeks on a weekly basis, with dressing changes twice a week. Ulcers were photographed and wound exudates were collected on admission and at days 5, 14 and then every 14 days to provide a visual record of any changes in appearance of the ulcer and healing rate and for biochemical analysis of the wound. The levels and activity of elastase and plasmin were measured in wound exudates. Statistical analysis was performed using ANOVA and Bonferroni's post hoc test with P-values <0·05 considered to be significant. Compared with controls, ORC/collagen matrix-treated pressure sore wounds showed a significant faster healing rate, which positively correlated with a decreased activity of elastase and plasmin in wound exudates. No signs of infection or intolerance to the ORC/collagen matrix were observed.

Oxidized Regenerated Cellulose/Collagen Dressings: Review of Evidence and Recommendations

“…These studies examined the use of ORC/collagen dressings to treat pressure ulcers, 28 , 29 VLUs, 30 – 33 and DFUs. 34 – 40 These trials have reported reduced elastase, MMPs, and reactive oxygen species in the wound 29 , 32 , 38 , 39 ; improved wound area reduction 29 , 30 , 35 , 40 ; increased number of healed wounds 28 , 36 ; and shortened time to heal 36 in patients treated with ORC/collagen dressings compared with controls (standard of care). One study noted that compared with control dressings, fewer ORC/collagen dressings were needed during the course of treatment and that patients in the intervention group had a shortened hospital length of stay.…”

The Effectiveness of Negative Pressure Therapy in Diabetic Foot Ulcers with Elevated Protease Activity: A Case Series

“…Oxidized regenerated cellulose/collagen matrix (ORC/collagen matrix) has been reported to improve the wound microenvironment by adsorbing wound exudate and retaining proteases within the dressing structure. [7][8][9][10][11][12][13] A randomized controlled trial demonstrated the superiority on modulating proteases of a wound dressing based on the LipidoColloid Technology, impregnated with a NanoOligo Saccharide Factor compared with an ORC/ collagen matrix. 14 A systematic review of the clinical evidence on protease-modulating dressing and researches that compare these devices would be useful in providing an overview of the appropriate treatment to achieve optimal healing for chronic wounds.…”

“…[7][8][9][10][11][12][13][14] Among these, negative pressure therapy (NPT) plays an interesting role. NPT is a noninvasive therapy system that applies controlled negative pressure using a vacuum-assisted closure device.…”

Cellulose/Collagen Dressings for Diabetic Foot Ulcer: A Review

“…The bacteria are a non-harmful pathogen that possess the ability to provide a moisture surface to improve the debridement process and to expedite the re-epithelisation in chronic ulcers. In a wet state, the membrane of the cellulose has 84–89% crystallinity property, mechanical strength, and the capability to absorb water [ 61 , 62 ], which gives the capacity to shorten the duration of healing phases [ 61 ]. Besides that, BC has been scientifically proven to be biocompatible, biodegradable, non-toxic, and exceptionally pure that chemically resemble cellulose-derived from plants.…”

“…Additionally, 52% of the subjects were completely healed by ORC dressing on the 14th week. No notable adverse effects or infection and a reduction in elastase were observed in patients receiving ORC treatments [ 62 ]. Elastase is a peptidase that is also a factor contributing to anti-healing by interfering with the synthesis of the collagen [ 48 ] and it can activate MMPs by degrading the existing connective tissue [ 82 ].…”