A Comparison of Collagenase to Hydrogel Dressings in Wound Debridement

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Catherine T. Milne, APRN, MSN, CWOCN; Armann O. Ciccarelli, MD, FACS; Mandie Lassy, BSN
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  Comparisons of collagenase to other methods of debridement, including wet to dry dressings, have been reported in the literature; however, studies comparing collagenase to hydrogel have not been reported. Objective. Time to complete necrotic tissue debridement with collagenase compared to hydrogel in institutionalized adults with pressure ulcers. Methods. Randomization occurred after obtaining informed consent to avoid selection bias. Subjects received daily dressing changes with either hydrogel or collagenase followed by a standard semi-occlusive dressing to evaluate time to debridement up to Day 42. Investigators, who were blinded to randomization, evaluated weekly wound photographs for necrotic tissue debridement and wound healing parameters using a digital planimetry software package. Nonviable tissue was not cross-hatched in either group. Results. Twenty-seven nursing home residents were enrolled over a period of 1 year. According to a Student’s t test, there were no significant differences between groups for age, gender, age of wound, or percentage of nonviable tissue at the time of enrollment (P = .03). Using a Pearson Chi square analysis, the collagenase group was found to have statistical (P = .003) significance in achieving full debridement by Day 42. Conclusion. This study showed statistical significance in favor of collagenase when used to debride nonviable tissue in pressure ulcers. Despite recommendations to cross-hatch eschar, statistical significance was still achieved when wounds were not cross-hatched, indicating clinical utility in settings without clinician availability for the cross-hatching procedure.

  Wound bed preparation (WBP) continues to be an essential component of chronic wound management. By addressing the relationship between necrotic tissues, exudate, bacterial and cellular dysfunction, an optimal wound healing environment can be achieved.1 The goal of debridement, integral to the WBP concept, is to remove necrotic tissue. Methods to achieve debridement include complete surgical excision, bedside sharp debridement, chemical/enzymatic/biological and autolytic agents, as well as mechanical agents. The choice of debridement methods depends upon the clinician, who considers wound characteristics and other local assessment findings, patient comorbidities, the time frame needed to achieve debridement, and the available skills and resources to safely manage the debridement process in the particular clinical setting.

  With the exception of surgical debridement, complete debridement of necrotic tissue in one patient encounter is a rarity.1 In nonspecialized outpatient, long-term care, and homecare settings, availability of a skilled clinician to provide bedside sharp debridement is very limited. Consequently, the use of chemical and autolytic debriding agents has been the primary method to achieve this aspect of WBP. Numerous studies have previously shown the debridement efficacy of chemical/enzymatic/biological agents when compared to wet-to-dry dressings.2 Wet-to-dry dressings are no longer considered standard of care, and there has been a shift in the literature that compares topical wound care therapies to moist wound care using hydrogel. No published studies have re-examined the efficacy of chemical/enzymatic/biological debriding agents to hydrogel in pressure ulcers.

  Enzymatic and autolytic debridement is frequently used in the long-term care setting as a simple, safe, and practical method to achieve the removal of nonviable tissue in the population served by these facilities.

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