Wound Healing in Partial-Thickness Burn Wounds Treated With Collagenase Ointment Versus Silver Sulfadiazine Cream

Hansbrough, John F.; Achauer, Bruce M.; Dawson, J. H. McL.; Himel, Harvey N.; Luterman, Arnold; Slater, H; Levenson, Stanley Μ.; Salzberg, C. Andrew; Hansbrough, Wendy; Doré, Christine

doi:10.1097/00004630-199505000-00004

Cited by 83 publications

(44 citation statements)

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“…72,83 While much of the Collagenase clinical trials literature is historical in nature is has to some degree shown the efficacy of collagenase in treating a wide variety of ulcers and burns. 68,81,[84][85][86][87] However more recently two more ''modern'' and placebo controlled trials have been carried out. A recent single-blinded, randomized study compared collagenase vs. hydrogel (SoloSite Ò Gel, Smith & Nephew, Largo, FL) for initial debridement in 27 institutionalized patients with pressure ulcers.…”

Section: Enzymatic Debridementmentioning

confidence: 99%

Optimizing Wound Bed Preparation With Collagenase Enzymatic Debridement

McCallon

Weir

Lantis

2014

Journal of the American College of Clinical Wound Specialists

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Difficult-to-heal and chronic wounds affect tens of millions of people worldwide. In the U.S. alone, the direct cost for their treatment exceeds $25 billion. Yet despite advances in wound research and treatment that have markedly improved patient care, wound healing is often delayed for weeks or months. For venous and diabetic ulcers, complete wound closure is achieved in as few as 25%-50% of chronic or hard-to-heal wounds. Wound bed preparation and the consistent application of appropriate and effective debridement techniques are recommended for the optimized treatment of chronic wounds. The TIME paradigm (Tissue, Inflammation/infection, Moisture balance and Edge of wound) provides a model to remove barriers to healing and optimize the healing process. While we often think of debridement as an episodic event that occurs in specific care giver/patient interface. There is the possibility of a maintenance debridement in which the chronic application of a medication can assist in both the macroscopic and microscopic debridement of a wound. We review the various debridement therapies available to clinicians in the United States, and explore the characteristics and capabilities of clostridial collagenase ointment (CCO), a type of enzymatic debridement, that potentially allows for epithelialization while debriding. It appears that in the case of CCO it may exert this influences by removal of the necrotic plug while promoting granulation and sustaining epithelialization. It is also easily combined with other methods of debridement, is selective to necrotic tissue, and has been safely used in various populations. We review the body of evidence has indicated that this concept of maintenance debridement, especially when combined episodic debridement may add a cost an efficacious, safe and cost-effective choice for debridement of cutaneous ulcers and burn wounds and it will likely play an expanding role in all phases of wound bed preparation.

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Section: Enzymatic Debridementmentioning

confidence: 99%

Optimizing Wound Bed Preparation With Collagenase Enzymatic Debridement

McCallon

Weir

Lantis

2014

Journal of the American College of Clinical Wound Specialists

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“…16 Collagenase cream proved better in removing necrotic debris than silver sulphadiazine; however, it showed almost similar healing times (19 days for collagenase vs 22 days for silver sulphadiazine). 17 When collagenase was added with polymyxin B sulphate/bacitracin spray, the healing time was reduced to 10 days (compared to 15 days for silver sulphadiazine alone). 18 Finally, biosynthetic dressings favoured wound regeneration processes when compared in controlled, randomised trials to silver-containing products: they significantly decreased pain and total healing time (10 days vs 15 days) without increasing the cost of out-patient burn care.…”

Section: Table 5 Healing Times For the Different Dressings Used Accormentioning

confidence: 99%

A retrospective analysis of ambulatory burn patients: focus on wound dressings and healing times

Gravante

Montone

2010

annals

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Ann R Coll Surg Engl 2010; 92: 118-123 118Dressings have always been an important issue in reconstructive surgery to obtain better aesthetic and functional outcomes. This is particularly true in burns, where infections and contractures are more frequent than in other fields. Over latter years, pharmacological research has produced several products with different purposes: avoidance of infection (i.e. silvercontaining products), promotion of re-epithelialisation (alginates, hyaluronic acid-derived products), or both.In the ambulatory facility of our burn centre, we use different products for different purposes. Although we try to use them according to burn thickness and local status, no clear guideline exists and much of the decision is often left to the surgeon's personal experience. During the last days of 2005, new silver-based products (nanocrystalline silverActicoat, Smith and Nephew, and silver carboxymethylcellulose -Aquacel Ag, Convatec) were introduced in our clinical practice. In the present study, we analysed burn outcomes, in terms of healing times, during the last 2 months of 2005 and the first 2 months of 2006, to see if changes in wound care corresponded to an amelioration of healing times. We also tried to correlate eventual differences with those obtained from other products already in use. Patients and MethodsAfter local Institutional Review Board approval was obtained, we gathered data from patients treated in the ambulatory facility of our burn centre during the last 2 months of 2005 and the first 2 months of 2006. We excluded from the study: (i) admitted patients; (ii) patients with mixed superficial partial thickness and deep partial thickness burns; (iii) patients with full-thickness burns; and (iv) operated (2006, 19; 2005, 29 days; Student's t-test, P < 0.01). Among all dressings, paraffin gauzes had the shortest healing times in superficial burns (5 days); with silver-based dressings in deep burns, the healing times were nanocrystalline silver (16 days) and silver carboxymethylcellulose (21 days). CONCLUSIONS Results of our retrospective study would suggest that paraffin gauzes are a valuable option in superficial burns, while silver-based dressings are preferable in deep burns. RECONSTRUCTIVE SURGERY

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“…Comparison of paired treatment sites within each patient demonstrated that proportionally more CCO-treated sites were cleaned (p < 0.001) and healed (p < 0.001) before similar sites treated with silver sulfadiazine. Time to clean wound bed (mean: 9.3 vs 11.6 days) and time to epithelialization (mean: 19.0 vs 22.1 days) were both numerically faster in sites treated with CCO compared with those treated with silver sulfadiazine, but the difference did not reach statistical significance [25]. Another prospective, randomized trial comparing CCO/polymyxin with silver sulfadiazine performed in 100 children with partial-thickness burns found no differences in outcomes in skin graft rates, length of stay and hospital costs between treatment groups [29].…”

Section: Effectiveness Of Cco In Debridement Of Burnsmentioning

confidence: 86%

“…An examination of the individual studies included in this adverse event analysis reported infrequent pruritus, rash, edema, erythema (one case in one study), burning sensation at wound site (similar frequency between groups in several studies), burn bed infection (in a single study, seven cases with collagenase vs one case in control group), herpes infection (one case in one study), mild bleeding (one case in one study) and cellulitis (several cases in several studies). However, the risk ratio of developing cellulitis was not found to be statistically significantly different between treatment groups on subgroup analysis by Patry et al [21][22][23][24][25][26][27][28][29][30], and a high risk of bias was noted by the Cochrane risk of bias tool among the majority of RCTs included. The systematic review and meta-analysis contained information from some, but not all, of the more recent studies in the literature as it was limited to RCTs, excluding cohort (prospective or retrospective) studies.…”

Section: Pharmacoepidemiology Of Cco Usementioning

confidence: 99%

“…The effectiveness of CCO in burn treatment has been demonstrated in several studies compared with surgical excision, silver sulfadiazine or MD, in both the hospital and outpatient burn center (Table 4) [25,29,[44][45]. Hansbrough et al conducted a trial in 79 patients (age range: 5-60 years) with partial-thickness burn wounds in which paired wound sites of comparable size and severity in each patient were randomized to treatment with either CCO with polymyxin B sulfate/bacitracin powder or silver sulfadiazine.…”

Section: Effectiveness Of Cco In Debridement Of Burnsmentioning

confidence: 99%

See 1 more Smart Citation

Comparative cost and clinical effectiveness of clostridial collagenase ointment for chronic dermal ulcers

Waycaster¹,

Carter

Gilligan

et al. 2018

J. Comp. Eff. Res.

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Chronic dermal ulcers affect approximately 2.4-4.5 million people in the USA and are associated with loss of function, decreased quality of life and significant economic burden. Debridement is a critical component of wound care involving removal of nonviable tissue from chronic wounds to stimulate the granulation and epithelialization process. Clostridial collagenase ointment has been used as a method of wound debridement for more than 50 years and is currently the only enzymatic debriding ointment with US FDA approval. This review discusses the results of recent real-world studies that build upon the evidence demonstrating the clinical effectiveness, cost-effectiveness and safety of clostridial collagenase ointment across wound types and care settings.

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Wound Healing in Partial-Thickness Burn Wounds Treated With Collagenase Ointment Versus Silver Sulfadiazine Cream

Cited by 83 publications

References 0 publications

Optimizing Wound Bed Preparation With Collagenase Enzymatic Debridement

Optimizing Wound Bed Preparation With Collagenase Enzymatic Debridement

A retrospective analysis of ambulatory burn patients: focus on wound dressings and healing times

Comparative cost and clinical effectiveness of clostridial collagenase ointment for chronic dermal ulcers

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