Effectiveness of collagen/oxidised regenerated cellulose/silver‐containing composite wound dressing for the treatment of medium‐depth split‐thickness skin graft donor site wounds in multi‐morbid patients: a prospective, non‐comparative, single‐centre study

Abstract

Split-thickness skin grafting (STSG) is a widely used method in reconstructive surgery, but donor site wounds (DSWs) are often slow healing and painful. This prospective study evaluated the performance of a composite wound dressing containing collagen/oxidised regenerated cellulose in the treatment of medium-depth (0·4 mm) DSWs in 25 multi-morbid patients with chronic leg ulcers requiring STSG. The range of patients' ages was 44-84 years (mean 71·6 years) with DSW sizes ranging between 12 and 162 cm (mean 78 cm ). Comorbidities included anticoagulation therapy (15 patients), anaemia (11 patients), diabetes (6 patients) and methicillin-resistant Staphylococcus aureus (MRSA) ulcer colonisation (6 patients). The first dressing change was performed after 10 days. Complete reepithelialisation was observed between the 10th and 34th day (mean 17·2, median 14 days). Postoperative medium to strong bleeding occurred in only five patients (four with anticoagulation). Wound pain levels one day after harvesting were only moderate (range 0-1·5, mean 0·5, median 0·5 on a six-item scale). No wound infection was observed during the first dressing. The composite dressing used allowed for the fast healing of medium-depth DSWs with minimal or no postoperative pain and bleeding in older multi-morbid patients under anticoagulation treatment.

Therapy of ulcus cruris of venous and mixed venous arterial origin with autologous, adult, native progenitor cells from subcutaneous adipose tissue: a prospective clinical pilot study

“…75 According to current data, moderate wound colonization (EWMA stage 2 and 3) has minor influence on wound healing compared to reduced microcirculation and malnutrition. 9,76,77 All four MRSA patients in our study showed rapid wound healing after SVF application. The patient with multiresistant E. coli colonization had a large, predominantly ischaemic AVLU as well as ankle arthrodesis and showed slight progression of the wound size, but no signs of progressive infection after treatment.…”

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

“… 42 The use of ORC/collagen dressings has also been examined in 25 skin graft donor sites in patients with multiple comorbidities and chronic leg ulcers. 43 Complete re-epithelialization was observed between 10 and 34 days postoperatively in all wounds. Two patients developed signs of infection after the first dressing change; however, antibiotics were not needed.…”

“…Two patients developed signs of infection after the first dressing change; however, antibiotics were not needed. 43 An article by Mees et al 44 describes a treatment pathway in 62 patients with postoperative infected abdominal wounds. These wounds were first treated antiseptically and then with antimicrobial advanced wound dressings until the wound improved to stage 1, followed by ORC/collagen/silver-ORC dressings in combination with alginate dressings.…”

“…Recommendations included the application of ORC/collagen dressings following sharp debridement, as part of wound bed preparation, prior to application of advanced modalities, and as an adjunct to advanced wound healing modalities. 37 , 42 , 43 , 58 , 81 Panel members also suggested using ORC/collagen/silver-ORC dressings in wounds with signs of infection, 40 , 41 as long as the infection is managed with appropriate debridement and antibiotic treatment.…”

Efeito in vitro da celulose oxidada regenerada, colágeno e prata na função dos fibroblastos oriundos de úlcera venosa

“…Estudo realizado por Ulrich et al 95 onde foi analisada ação de ORC/colágeno no exsudato de feridas diabéticas concluiu que ORC/colágeno apresentou a propriedade de diminuir os níveis de MMPs (MMP-2) do exsudato havendo melhor evolução das feridas, corroborando com outras publicações. Também foi testada a capacidade de proliferação desses fibroblastos expostos a três diferentes concentrações de ORC/colágeno (1.4, 2.8 e 4.2 mg/mL) sendo observada maior proliferação nas concentrações 2.8 e 4.2 mg/mL.Assim, os estudos apresentados sugerem que a ORC/colágeno possui a propriedade de estimular a proliferação de fibroblastos, diminuir a concentração de MMPs no microambiente da ferida, proteger fatores de crescimento21,87,94,95 e ainda quando associada à prata agregar característica de diminuir a proliferação de microrganismos e evitar infecção23,96 .Contudo, apesar dos estudos previamente citados, ainda há lacunas quanto a interferência da ORC/colágeno, associada ou não à prata, no componente celular presente no leito de úlceras crônica, assim, em nosso estudo pretendemos verificar a ação in vitro dessas substâncias em fibroblastos oriundos de úlcera venosa, buscando elucidar efeitos desse curativo nos processos celulares e consequentemente no microambiente da ferida. Todas as feridas apresentavam tecido de granulação em moderada quantidade, pouco ou nenhum tecido necrótico e ausência de sinais clínicos de infecção e não estavam sendo tratadas com curativo contendo prata na sua composição.…”