Hyaluronic Acid/Collagenase Ointment in the Treatment of Chronic Hard-to-Heal Wounds: An Observational and Retrospective Study

Abstract

Background: Wound bed preparation is an important concept in clinical practice and is related to adequate debridement. The use of proteolytic enzymes is an established method of enzymatic wound debridement, especially in hard-to-heal ulcers that are unresponsive to normal healing procedures and progress. The TIME framework (tissue, inflammation/infection, moisture balance, and edge of wound) offers an appropriate strategy to eliminate resistance to healing, as well as maximizing the healing process. Maintenance debridement, as opposed to sporadic debridement, may be proposed in preserving an adequate wound bed towards complete recovery. Collagenase has been effective in debridement due to its ability to degrade collagen and elastin. In this clinical context, collagenase taken from Vibrio alginolitycus is the most favorably expressed enzymatic debriding agent. Methods: This retrospective observational study evaluates the efficacy of an ointment based on hyaluronic acid and collagenase (Bionect Start®), considering a reduced healing time and greater healing quality. We included 70 patients with chronic wounds of different etiologies, including diabetes mellitus (20), post-traumatic ulcers (35), chronic burns of degrees I and II (10), and pressure ulcers (5). We analyzed wound characteristics using the wound bed score (WBS) concept, healing time, as well as operator and patient satisfaction. Results: Frequency of debridement efficacy in terms of wound bed cleansing varied from 26% after 2 weeks to 93% after 4 weeks. We observed complete healing in 62 patients within an eight-week period. The overall operator and patient satisfaction after 8 weeks were 100% and 90%, respectively. Moreover, all patients reported less pain. Conclusions: A combined action of hyaluronic acid and collagenase ointment demonstrated a reduction in healing time while improving healing quality, with a decrease in pain.

Fragmented Dermo-Epidermal Units (FdeU) as an Emerging Strategy to Improve Wound Healing Process: An In Vitro Evaluation and a Pilot Clinical Study

“…Furthermore, a clinical evaluation of the skin trophism was conducted during the follow-up sessions, with significant improvements observed compared to the baseline properties. The results are in line with previous studies, revealing the structural remodeling potential of PRP [46], leading to the disposal of hyaluronic acid and glycosaminoglycan expression as well as modulate matrix metalloproteinase and tissue inhibitor metalloproteinase equilibrium [47,48].…”

Effect of Hyaluronic Acid Iontophoresis on Healing of Chronic Venous Ulcer

“…The study observed a minimal to 100% reduction in wound size, notably diminished exudate excretion, healthy wound edge, and lower pain score. 9 Nosseir et al, (2018) compared between the effectiveness of estrogen iontophoresis as physical therapy modality and stem cell therapy in the treatment of diabetic foot ulcers. Results showed that estrogen iontophoresis for 4 weeks in combination with stem cell is an effective adjuvant therapy, better that each method alone, in treatment of diabetic foot ulcers through accelerating wound healing and reducing WSA, wound volume.…”

Advances in the Preparation of Nanofiber Dressings by Electrospinning for Promoting Diabetic Wound Healing

“…(2) Enzymatic debridement dressing: Enzymatic debridement is a method that uses chemical reagents to identify and break down inactivated tissue, usually in smaller wounds and wounds with selective microenvironments that do not require intervention. Enzymatic debridement dressing has the advantages of being cost-effective and efficient [ 49 , 50 ]. (3) Antiseptic dressings: Some research suggests that debridement alone is not sufficient to accelerate chronic wound healing and recommends the use of antiseptics to complement the debridement process and control infection.…”