Use of collagenase ointment in conjunction with negative pressure wound therapy in the care of diabetic wounds: a case series of six patients

Abstract

BackgroundDiabetic wounds with additional comorbidities are costly, time intensive, and difficult to heal. Often, multiple modalities may be necessary to achieve wound resolution, relying on the synergistic advantage of each therapy to affect wound healing. The selectivity of Clostridium collagenase is physiologically effective at degrading non-viable collagen fibers while preserving living collagen tissue. Additionally, negative pressure wound therapy (NPWT) has long been used to aid wound healing while concurrently depreciating biological wound burden time.MethodsSix patients were selected from those appearing to our university based limb salvage service. Inclusion criteria included patients with a recurrent mixed fibrotic and granular wound base, in which NPWT was indicated, without exclusion criteria. Patients enrolled were administered clostridial collagenase ointment at each regularly scheduled NPWT dressing change. Patients were followed until healing, with visual representations of wound progression and time to full healing recorded.ResultsTandem application of these therapies appeared to expedite wound healing by clearing degenerative fibrous tissue and expediting wound granulation without additional complication. Unfortunately, not all patients were able to reach full healing; with two patients experiencing ulcer recurrence, likely a result of their significant comorbid nature.ConclusionIn our experience, we have noticed a specific subgroup of patients who benefit greatly when collagenase enzymatic debridement therapy is combined with NPWT. It is our belief that this combination therapy combines the molecular clearing of non-viable collagen with the wound granulation necessary to advance complex wounds to the next step in healing despite the current paucity in literature discussing this specific pairing.

Conhecimento de enfermeiros sobre o uso da colagenase em lesões por pressão

“…Thus, after digestion of these fibers, the tissue can easily be removed. 9,18 The enzyme acts by breaking the apolar region of the structure of the collagen fiber formed by amino acid sequences. Thus, after cleavage of the apolar region, peptides with higher molecular weight are formed due to fiber lysis, which will be more easily digested by collagen-specific peptidases and also by non-specific proteases.…”

“…Understanding and mastering aspects related to the substance consistency, need for replacement of collagenase by another type of covering, promotion of moisture in the wound bed associated with drug use, length of stay of the covering and need for exchange when using ointment, contraindications, posology criteria, and possible adverse reactions are aspects that should be taken into consideration by nurses when they opt for collagenase as a curative mode to promote the healing of the lesion. 18,21 The constant search for knowledge and its apprehension give nurses greater confidence and scientific rigor that supports the development of a good work practice, being expressed in their discourse and even in the performance of their activities.…”

Nurses and the use of collagenase in the treatment of chronic wounds

“…Thus, it is important that occurs thorough evaluation of the lesion from its source, location, size of the lesion bed characteristics, such as types of tissue present (vitalized or not), signs of infection and the presence of cavities, in addition adjacent skin. Systemic and psychosocial character condition of the patient should also be taken into account in the evaluation time, such as nutritional status, comorbidities, age, medications used, financial and social conditions to cooperate for the treatment and health keeping [6]. This fact will ensure the nurse accurate and actual situational conditions about the injury and it may take care holistically based on resolving interventions.…”

“…This particularity makes one of topical products of choice for the treatment is preferably collagenase [6].…”

“…For collagenase to be used properly and judiciously, there is a priority for the nursing professional, as well as to know about this product used to treat wounds, systematize this assistance, thus performing the steps of the nursing process through holistic and systematic evaluation the wound and the patient, thus enabling nurses to the construction and implementation of the treatment plan, monitoring, and documentation of results from the interventions, which will provide means for the attainment of its main objective included in the care process: the progression of injury, satisfying your customer [4,6].…”