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.
Highlights
Introduction iationsWound healing is a complex biological repair procedure commonly developing in four concurring stages, including hemostasis, inflammation, proliferation and remodeling [1].This elaborate and precarious procedure is moderately effective but may degenerate, causing chronic wound (CW) conditions, which are unresponsive to a natural biological healing mechanism
The mechanism concurring to CW varies considerably but involves metabolic diseases [4], factors influencing blood supply [5], elderly age [6], peripheral neuropathy [7], infection [8], malnutrition [9], altering of immune function, medications, or previous local tissue injury
A second assessment was performed after 2 weeks to confirm complete healing of the wound, according to AHRQ recommendations. the wound bed score [36] was adopted to evaluate black eschar, eczema/dermatitis, depth, scarring, colour of wound bed, oedema, resurfacing epithelium, exudate amount (Table 2)
Summary
Wound healing is a complex biological repair procedure commonly developing in four concurring stages, including hemostasis, inflammation, proliferation and remodeling [1]. This elaborate and precarious procedure is moderately effective but may degenerate, causing chronic wound (CW) conditions, which are unresponsive to a natural biological healing mechanism. Such CW may remain at a proliferative or inflammatory state of wound healing [2] and typically revert to an inflammatory state [3] due to specific biochemical, microbial, and cellular abnormalities that interfere with healing progression (Figure 1). Collagenase taken from Vibrio alginolitycus is the most favorably expressed enzymatic debriding agent
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