Significance: Broad-spectrum metalloproteinase (MMP) reduction along with inherent aspects of an extracellular matrix (ECM) dressing can bring about improved wound healing outcomes and shorter treatment duration. Initial reports of clinical effectiveness of a new ovine-based collagen extracellular matrix (CECM) dressing demonstrate benefits in chronic wound healing. Recent Advances: CECM dressings are processed differently than oxidized regenerated cellulose/collagen dressings. CECM dressings consist primarily of collagens I and III arranged as native fibers that retain the three-dimensional architecture present in tissue ECM. As such, ovine-based ECM dressings represent a new generation of collagen dressings capable of impacting a broad spectrum of MMP excess known to be present in chronic wounds. Critical Issues: While MMPs are essential in normal healing, elevated presence of MMPs has been linked to wound failure. Collagen has been shown to reduce levels of MMPs, acting as a sacrificial substrate for excessive proteases in a chronic wound. Preserving collagen dressings in a more native state enhances bioactivity in terms of the ability to affect the chronic wound environment. Clinical observation and assessment may not be sufficient to identify a wound with elevated protease activity that can break down ECM, affect wound fibroblasts, and impair growth factor response. Future Directions: Collagen dressings that target broad-spectrum excessive MMP levels and can be applied early in the course of care may positively impact healing rates in difficult wounds. Next-generation collagen dressings offer broader MMP reduction capacity while providing a provisional dermal matrix or ECM. SCOPE AND SIGNIFICANCESelecting treatment based on a scientific understanding of the pathological condition of a chronic wound is important in addressing cost and patient needs. Harmful effects of excessive metalloproteinase (MMP) activity in chronic wound healing should be a consideration of wound care decision making. Collagen dressings have been shown to reduce MMP levels, acting as a sacrificial substrate for excessive proteases in chronic wounds. 1-3New ovine-based collagen extracellular matrix (CECM) dressings (EndoformÔ dermal template; Hollister Wound Care, Libertyville, IL) exhibit broad-spectrum MMP inhibition and can serve as a provisional matrix to affect cellular signaling and differentiation that may enhance wound healing. 2 TRANSLATIONAL RELEVANCEDegradation of collagen is important for the physiological remodeling of connective tissues during wound healing. Extracellular degradation of collagen fibers is mediated by MMPs and is a multistep process. A collagen dressing with a preserved structural component can serve as a provisional ECM dermal template and influence cellular interaction necessary to encourage keratinocyte migration. 4 CECM dressings have been shown to retain the complex collagen architecture of native tissue ECM as well as the ECM-associated secondary molecules, including laminin, fibronectin, and glycosam...
The likelihood of DFU healing is increased with off-loading adherence, and, current evidence favors the use of nonremovable casts or fixed ankle walking braces as optimum off-loading modalities. There currently exists a gap between what the evidence supports regarding the efficacy of DFU off-loading and what is performed in clinical practice despite expert consensus on the standard of care.
Pressure ulcers (PrUs) affect approximately 2.5 million patients and account for 60,000 deaths annually. They are associated with an additional annual cost of $43,000 per related hospital stay and a total cost to the US health care system as high as $25 billion. Despite the implementation of national and international PrU prevention guidelines and toolkits, rates of facility-acquired PrU s and PrUs in people with spinal cord injury are still high. A new paradigm is needed that distinguishes between prevention and treatment research methods and includes not only the causative factors of pressure and tissue deformation but also patient-specific anatomical differences and the concomitant biological cellular processes, including reperfusion injury, toxic metabolites, ischemia, cell distortion, impaired lymphatic drainage, and impaired interstitial fluid flow that compound existing tissue damage.
The purpose of this study was to describe the rate of closure observed in venous leg ulcers during treatment with ovine collagen extracellular matrix dressings and compression. Fourteen patients with 23 wounds were retrospectively evaluated with respect to healing rates, time to closure, and weekly facility charge fees.
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