Chlorophyllin?A Healer? A Hypothesis for its Activity
Abstract: Chlorophyllin has a long history of use in medicine. It has found utility as an active ingredient in several topically applied enzymatic debridement agents. The literature describes the biochemical and clinical implications of chlorophyllin. The following review describes chlorophyllin?s mode of action and reasons for its initial use in papain-urea-based enzymatic debridement agents. In addition, a critical review investigates whether it is biochemically feasible to describe chlorophyllin as a wound-healing agent.
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A Prospective, Randomized, Comparative Study of Collagenase and Papain-Urea for Pressure Ulcer Debridement
Abstract: Objective: To evaluate and compare the ability of two commercial chemical debridement ointments to effectively remove devitalized tissue and promote granulation in pressure ulcers requiring debridement. One of the test agents was an enzymatic formulation (collagenase) and the other a formulation of papain and urea. Design: This study was a prospective, randomized, parallel group, tri-center, open-label, clinical trial with a two-week screening period to stabilize the wound and an evaluation period of four weeks in duration. Setting: The patients who participated in the trial were nursing home residents in northern New Jersey. Participants: Twenty-eight patients were randomly assigned to ulcer treatment with either collagenase debriding ointment (n = 12) or papain-urea debriding ointment (n = 14). Two patients dropped out early due to unrelated treatment issues. Measurements: Wounds were treated once daily until complete debridement or four weeks. The major outcome of nonviable (necrotic) tissue reduction (determined by planimetry) was assessed weekly by intention to treat. The amount of nonviable tissue, degree of wound granulation, and overall wound response were evaluated weekly using a visual scale. Wound area measurements were performed by morphometric analysis of perimeter tracings. Results: The papain-urea debriding ointment was significantly more effective (p < 0.0167) than the collagenase ointment in reducing the amount of necrotic tissue at each of the three prospectively determined weekly evaluations. Development of granulation tissue in wounds treated with papain-urea was significantly enhanced as compared to wounds treated with collagenase. Epithelialization generally correlated with the development of a granulating wound bed as determined by visual assessment. However, the general increase in the amount of epithelial tissue associated with the papain-urea-treated wounds did not predict a significantly different rate of reduction in the actual wound area. Conclusion: This study evaluated th
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Debridement: Rationale and Therapeutic Options
Abstract: Debridement is commonly defined as the process of removing necrotic, devitalized tissue and foreign material from a wound. The presence of necrotic tissue within a wound may impair wound repair processes by stimulating inflammation and delaying granulation and epithelialization. However, the above definition of debridement may not tell the whole story. Debridement may additionally remove senescent cells from the wound bed and nonmigratory cells from the ulcer edge and also remove excessive or abnormal bacteria; all of which may allow for improved availability of growth factors. This supplement will review the rationale for debridement, existing clinical data supporting debridement, and the various debridement options available. The supplement was supported through an unrestricted education grant from Healthpoint Ltd., Ft. Worth, Texas.
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Wound Bed Preparation: The Science Behind the Removal of Barriers to Healing [PART 1]
Abstract: Wound healing involves a well-orchestrated, complex process leading to repair of injured tissues. However, chronic wounds do not follow the normal pattern of repair. This is due to underlying physiological problems associated with their development, which unless corrected would continue to cause wound deterioration. The key to effective wound care lies in a combination of three approaches: treatment of underlying medical problems, assessment and treatment of local wound bed, and effective management of any patient-centered concerns. An essential component of this recommended approach is restoration of healthy granulation tissue in the wound bed. Wound bed preparation brings a number of existing procedures, including debridement, treatment of infection, and management of exudate levels, together into a systematic approach to help restore the chronic wound bed environment. The aim of wound bed preparation is to remove the barriers to healing and initiate the repair process. This review explores the scientific rationale behind this concept and examines how wound bed preparation offers healthcare professionals an improved paradigm for the treatment of chronic wounds. By implementing wound bed preparation, the formation of healthy granulation tissue will be optimized and the efficiency of biotechnological therapies improved, which would ultimately reduce the time to wound closure.
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Debridement: Rationale and Therapeutic Options
Abstract: Debridement is commonly defined as the process of removing necrotic, devitalized tissue and foreign material from a wound. The presence of necrotic tissue within a wound may impair wound repair processes by stimulating inflammation and delaying granulation and epithelialization. However, the above definition of debridement may not tell the whole story. Debridement may additionally remove senescent cells from the wound bed and nonmigratory cells from the ulcer edge and also remove excessive or abnormal bacteria; all of which may allow for improved availability of growth factors. This supplement will review the rationale for debridement, existing clinical data supporting debridement, and the various debridement options available. The supplement was supported through an unrestricted education grant from Healthpoint Ltd., Ft. Worth, Texas.
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Standard, Appropriate, and Advanced Care and Medical-Legal Considerations: Part One?Diabetic Foot Ulcerations (A)
Abstract: Administration of prompt and appropriate care for diabetic foot ulcerations is necessary to reduce complications, which may lead to limb loss. An understanding of standard, appropriate, and advanced care may assist the physician in making the most optimal decision when treating diabetic foot ulcers. An overview of the diabetic foot, its associative problems, considerations when reviewing the diabetic patient, and approaches to treatment are presented in this article. Clinicians are encouraged to review each patient individually to determine their specific needs and to administer the most appropriate care.
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The Biological Mechanisms Behind Injury and Inflammation: How They Can Affect Treatment Strategy, Product Performance, and Healing
The processes behind tissue response to injury and innate immunity are integral parts of the acute wound response and the initiation of repair. In addition, inflammation is a key factor influencing both positive and negative aspects of healing in chronic wounds. Biological data on the signaling mechanisms behind these basic processes has increased dramatically over the last 10 years, yet the products and practice of wound healing have not benefited to the fullest extent from this new knowledge. An in-depth analysis of the biological mechanisms underpinning the processes that impact healing was undertaken to discover ways this information might be used to improve the treatment of chronic wounds. A synopsis of findings is presented regarding the biological mechanisms at work in injury and inflammation. It examines the early stages of wound healing from a mechanistic, biological perspective to gain insight into how this information might translate to the better use and development of wound healing products. These biological processes can impact the effectiveness of treatment from wound bed preparation to potentially regenerative products like growth factors and bioengineered skin constructs. The authors conclude that approaching wound healing from the perspective of biological mechanism can improve how effectively wounds are treated today. As importantly, viewing the development of wound care and wound healing products from the perspective of biological mechanism can lead to new ways of treating wounds that achieve greater clinical significance.
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April 2006
The authors state that better cosmetic outcomes and fewer problems with hypertrophic scars may be attributed to the use of collagenase. The authors also state that during the last stages of wound management barrier dressings were used. The term barrier dressing refers to semi-permeable materials.
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March 2006
2. The absorption tests were carried out for 20 seconds, which is inappropriate for most dressings on the market. In all tests, nonwoven A (AQUACEL® Ag, ConvaTec, Skillman, NJ, USA) comes out the best. The term barrier dressing refers to semi-permeable materials.
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Clinical and Economic Impact of Hydrosurgical Debridement on Chronic Wounds
Abstract: The high-powered parallel waterjet is a new surgical debridement tool that precisely removes tissue using a high-energy water beam. In this retrospective study, 20 patients with chronic wounds who were operatively debrided with the high-powered parallel waterjet were compared with 14 chronic wound patients debrided with conventional instruments. The hydrosurgery patients required a mean of 1.14 surgeries to obtain a prepared wound bed compared to 2.0 surgeries for conventional patients. This improvement in patient outcomes resulted in approximate savings of $2,800 for the hospital, per patient, when using the waterjet. The introduction of this new surgical technology has changed the paradigm for surgical debridement of chronic wounds.
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