Autolytic Debridement Research Articles

Ultrasonic-assisted wound debridement for scleroderma digital ulcers

Debridement is a key element of wound care. It involves the removal of devitalized tissue from the wound bed in order to allow wound healing. Microcirculatory ulcers in general and scleroderma ulcers in particular are extremely painful, very reactive and rather unwilling to accept aggressive local treatments of a mechanical type or surgical cleaning which can promote an abnormal phlogistic response with a necrotizing evolution. For the elimination of devitalized tissue is necessary to promote autolytic or enzymatic debridement with slow tendency towards healing frequently exposed to phlogistic infections furthermore slowing healing with high risk of gangrene and amputation. Ultrasonic-assisted wound debridement uses low frequency ultrasound waves showing three clinical effects: atraumatic selective tissue debridement, wound stimulatory effect and antibacterial activity. We compare healing time, infections and procedural pain of ultrasonic debridement with autolytic debridement as for Scleroderma digital Ulcers. There is evidence to show that Ultrasonicassisted wound debridement reduces the time of healing, needing for antimicrobial therapy, the procedural pain and consequently the cost to the healthcare system improving the patients’ quality of life.

Hronične rane u primarnoj zdravstvenoj zaštiti

For modern societies, chronic wounds and their treatment represent a health problem for whose treatment significant amounts of money are allocated since two percent of the total population suffer from a chronic wound with chronic venous ulceration as the most common. For patients with chronic wounds, the quality of life is significantly lower, the treatment is long-lasting and often multidisciplinary. The presence of diabetes, makes the treatment significantly longer. In order to achieve epithelization and healing of a chronic wound, it is necessary to treat not only wounds, but also the basic disease and comorbidity, however it depends on the patient's motivation for treatment as well as on the availability of therapeutic resources. The treatment of chronic wounds by applying modern dressings which allow autolytic debridement and healing of the wounds is based on the concept of 'controlled moisture' which greatly accelerates the wound healing process.

A study to assess the chemical composition and antibacterial properties of honey

The present study was to assess the chemical composition and antibacterial properties of honey. From ancient times, honey was increasingly used as a remedy for wound healing. Globally, several studies have been conducted and proved that there are a numerous ways that honey can heal the wound. To accept that honey has medical property in wound healing there is limited evidence. Hence the researcher was interested to determine the chemical composition and anti-bacterial properties of honey. It was assumed that honey has antimicrobial, anti-oxidant, anti-inflammatory properties as per the literature review. Also is acidic with high osmolality. Honey also has an antioxidant property that protects the cells from free radicals. Clinically topical application of honey possess antimicrobial properties, promote autolytic debridement, deodorize malodorous wounds, stimulate growth of wound tissues to fasten healing, stimulate anti-inflammatory activity and promote moist wound healing. Thus the use of honey can be effective and economical approach to managing large wounds. An experimental approach is carried out to fulfil the objective in a controlled setting. Whole honey has been sent to the laboratory for compound isolation through column chromatography. Three compounds have been isolated namely compounds (1-3). The isolated compound along with whole honey and standard antibiotics were send to the clinical laboratory for antibacterial study with selected pathogens. The results showed compound-2 had a good antibacterial effect against pathogens like E. coli, Klebsiella, Staphylococcus albus, Staphylococcus aureus while comparing with compound 1 and compound 2. Against Pseudomonas the compound has no effective antibacterial effect. Hence it is concluded that honey can be a potential treatment for diabetic foot ulcer caused by pathogens.

A case report of diabetic foot ulcer underwent an autolytic debridement using hydrogel and hydrocellular foam combination

Background: All diabetic patients have 15-20% risk of foot ulcer during a lifetime. Approximately 70% diabetic ulcers heal within five years. However, the healing is often slow, and the ulcer may become a chronic wound. Proper treatment can improve the healing process. It includes autolytic debridement. It is a process in which the body removes the necrotic tissue. Case: A female, 45-year-old complained wound on her right foot since 1.5 months ago. The wound did not heal and became larger with bad odor and pus. She had type 2 diabetes mellitus since five years ago with uncontrolled blood sugar. We performed surgical debridement to extend the wound and to drain the pus. We used a combination of hydrogel and hydrocellular foam to treat h wound. Conclusion: The overall performance of a combination of hydrogel and hydrocellular foam was shown to have clinical advantages such as autolytic debridement. We observed an increase of wound granulation and epithelialization and a decrease of slough and exudates.Â

Economic analysis and budget impact of clostridial collagenase ointment compared with medicinal honey for treatment of pressure ulcers in the US.

ObjectivesPressure ulcer (PU) treatment poses significant clinical and economic challenges to health-care systems. The aim of this study was to assess the cost-effectiveness and budget impact of enzymatic debridement with clostridial collagenase ointment (CCO) compared with autolytic debridement with medicinal honey (MH) for PU treatment from a US payer/Medicare perspective in the hospital outpatient department setting.MethodsA cost-effectiveness analysis using a Markov model was developed using a 1-week cycle length across a 1-year time horizon. The three health states were inflammation/senescence, granulation/proliferation (ie, patients achieving 100% granulation), and epithelialization. Data sources included the US Wound Registry, Medicare fee schedules, and other published clinical and cost studies about PU treatment.ResultsIn the base case analysis over a 1-year time horizon, CCO was the economically dominant strategy (ie, simultaneously conferring greater benefit at less cost). Patients treated with CCO experienced 22.7 quality-adjusted life weeks (QALWs) at a cost of $6,161 over 1 year, whereas MH patients experienced 21.9 QALWs at a cost of $7,149. Patients treated with CCO achieved 11.5 granulation weeks and 6.0 epithelization weeks compared with 10.6 and 4.4 weeks for MH, respectively. The number of clinic visits was 40.1 for CCO vs 43.4 for MH, and the number of debridements was 12.3 for CCO compared with 17.6 for MH. Probabilistic sensitivity analyses determined CCO dominant in 72% of 10,000 iterations and cost-effective in 91%, assuming a benchmark willingness-to-pay threshold of $50,000/quality-adjusted life year ($962/QALW). The budget impact analysis showed that for every 1% of patients shifted from MH to CCO, a cost savings of $9,883 over 1 year for a cohort of 1,000 patients was observed by the payer.ConclusionThe results of these economic analyses suggest that CCO is a cost-effective, economically dominant alternative to MH in the treatment of patients with PUs in the hospital outpatient department setting.

Comparative Effectiveness of Clostridial Collagenase Ointment to Medicinal Honey for Treatment of Pressure Ulcers.

Objective: Compare enzymatic debridement using clostridial collagenase ointment (CCO) with autolytic debridement using medicinal honey in the hospital outpatient setting for treating pressure ulcers (PUs).Approach: Retrospective deidentified electronic health records from 2007–2013 were extracted from the U.S. Wound Registry. Propensity score matching followed by multivariable analyses was used to adjust for selection bias and assess treatment effects comparing CCO-treated versus honey-treated PUs. Key outcomes included 100% granulation and epithelialization at 1 year.Results: Five hundred seventeen CCO-treated PUs (446 patients) were matched to corresponding honey-treated PUs (341 patients). The majority of PUs were stage III (CCO 56%, honey 55%). CCO users had significantly fewer total visits (9.1 vs. 12.6; p < 0.001), fewer total selective sharp debridements (2.7 vs. 4.4; p < 0.001), and fewer PUs receiving negative pressure wound therapy (29% vs. 38%; p = 0.002) compared with honey.Innovation: CCO-treated PUs were 38% more likely to achieve 100% granulation compared to honey-treated PUs at 1 year, p = 0.018. Mean days to 100% granulation were significantly lower for CCO-treated PUs (255 vs. 282 days, p < 0.001). CCO-treated PUs were 47% (p = 0.024) more likely to epithelialize at 1 year compared to PUs treated with honey. Mean days to epithelialization were significantly lower for PUs treated with CCO at 1 year (288 vs. 308 days; p = 0.011).Conclusion: All stages of PUs treated with CCO achieved faster rates of granulation and subsequent epithelialization compared to PUs treated with medicinal honey as measured by real-world data collected in the hospital outpatient department care setting.

Autolytic debridement and management of bacterial load with an occlusive hydroactive deressing impregnated with polyhexamethylene biguanide.

Background:Debridement and control of bacterial load are key-points of wound care. The aim of this study is to evaluate the effectiveness of autolytic debridement and management of bacterial load (bioburden) of an occlusive hydro-active dressing impregnated with polyhexamethylene biguanide (PHMB).Methods:We used an occlusive dressing of hydro-active for leg ulcers’ treatment (TenderWet-plus® – Hartmann). Inclusion criteria were: presence of a fibrinous ulcer with multiple etiopathogenesis, in absence of clinical infection, no hypersecretion and diameter within 5 cm. Swab for bacterial bioburden control were made at start of the study, after 3 and 7 days. We made also a measurement of the amount of granulation tissue and of pain with VAS scale; bacterial bioburden control inside the dressing was made too.Results:28 leg ulcers were treated (12 venous, 5 diabetic, 8 thraumatic, 3 mixed) in 25 patients. The ulcer has been completely covered with fibrin in almost all cases and the bacterial load was represented mainly by Staphylococcus aureus (80% of the cases) with a load within 10.000UFC/plate in 81,5% of the cases. Control at 3 and 7 days have shown the appearance of granulaton tissue up to 67,8% of the wound surface. Bacterial bioburden (load) remained constant in 50% of the cases, decreased in 15%, increased in 35% of the cases.Conclusion:TenderWet-plus® has proven to be effective and quick in autolytic debridement and at the same time be able to handle the bacterial load in most cases. It can then be used for home treatment. (www.actabiomedica.it)

Hybrid Amniotic Membrane Dressing with Green Silver Nanoparticles as Bioengineered Skin for Wounds and Burns: A Pilot Studies

Fabrication of 3D novel scaffolds is very challenging and critical to achieve the appropriate function for tissue regeneration. This study aims to develop a hybrid biological nano-scaffold using Liquid nitrogen (LN2) decellularised human amniotic membrane (hAM), human umbilical cord derived collagen nano-fibres and green silver nanoparticles obtained by green synthesis of curcumin. A novel attempt was made to develop in vitro bioengineered dermal layer by seeding the scaffold with cord blood derived Mesenchymal stem cells (CBMSCs) and trans-differentiating them to keratinocytes and dermal fibroblast like cells using keloid foreskin conditioned media. Furthermore, the small animal experiments in Albino Wistar rats prove it to be a safe healing product without scar formation. This novel scaffold can be a promising dressing material for none healing ulcers and burns. This scaffold has long shelf life, easy to apply, have sustained/controlled release of silver, the minimum frequency of dressing changes, manage excessive exudates, moisture retainment, reduce inflammation and facilitate autolytic debridement.

Testing the influence of surfactant-based wound dressings on proteinase activity.

Proteinases are enzymes that can digest other proteins. In chronic wounds, a sub-class of these enzymes with the ability to degrade the extracellular matrix (matrix metalloproteinases, MMPs) have been found to both inhibit healing and to be able to aid in enzymatically debriding a wound. Enzymatic debridement using the enzymes present in a wound is generally called autolytic debridement. Clinicians seeking to employ autolytic debridement typically use occlusive materials such as medical honey, alginate dressings and other occlusive dressings. A relatively new class of gel dressings comprised of surfactants are now available for clinical use. A variety of surfactants are used in the study of MMP biochemistry. Surfactants can deactivate MMPs or can enhance their activity, depending on the surfactant. In order to begin to understand how the MMPs found in chronic wounds would respond to these new dressings, we tested a serial dilution series of two of the currently available surfactant-based dressings to determine their effects on four separate MMPs. The dose-response versus MMP activity of bacterial collagenase, host-derived MMP-8 and MMPs-2 and -9 was assessed using a simple mix-and-read fluorescent peptide activity assay. The enzyme's native activity in the absence of the gel was used to compare against the surfactant-treated samples. We found that the surfactant affected the proteinase activity differently for each enzyme. The activity of the bacterial collagenase was increased at low concentrations but slightly inhibited as the concentrations increased. The host MMP-8 collagenase responded similarly in that it was inhibited at higher concentrations. Interestingly, both MMP gelatinases presented with substantially increased activities, with MMP-2 increased to 200% of native activity, while MMP-9 presented with an increase of 300% activity over the same concentration range. MMPs appear to respond to a surfactant-based gel dressing differentially, with the MMP most commonly elevated in chronic wounds having the highest boost to activity. In wounds with elevated MMPs, our data suggest that the use of these surfactant-based dressings would be expected to enhance the activity of MMPs 2 and 9 gelatinases while simultaneously inhibiting MMP-8 collagenase. Hypothetically, this imbalanced effect would support a protection of the native dermal collagen and removal of denatured materials. However, the demonstration of these anticipated consequences is still being investigated.

Autolysis: mechanisms of action in the removal of devitalised tissue.

Chronic wounds affect millions of people worldwide. In the UK alone, the cost of their treatment is estimated to be between £4.5bn and £5.1bn. The implementation of wound-bed preparation strategies remove the barriers to healing and wound debridement is a key component in preparing the wound bed for wound progression. This article aims to review one of the several debridement methods available to clinicians: autolytic debridement. Autolysis (i.e. autolytic debridement) uses the body's own enzymatic mechanisms to remove devitalised tissue in order to remove the barriers to healing. This review aims to provide clinicians working in wound care with a better understanding of the mechanisms and implications of autolytic debridement.

Biological properties and therapeutic activities of honey in wound healing: A narrative review and meta-analysis

For thousands of years, honey has been used for medicinal applications. The beneficial effects of honey, particularly its anti-microbial activity represent it as a useful option for management of various wounds. Honey contains major amounts of carbohydrates, lipids, amino acids, proteins, vitamin and minerals that have important roles in wound healing with minimum trauma during redressing. Because bees have different nutritional behavior and collect the nourishments from different and various plants, the produced honeys have different compositions. Thus different types of honey have different medicinal value leading to different effects on wound healing. This review clarifies the mechanisms and therapeutic properties of honey on wound healing. The mechanisms of action of honey in wound healing are majorly due to its hydrogen peroxide, high osmolality, acidity, non-peroxide factors, nitric oxide and phenols. Laboratory studies and clinical trials have shown that honey promotes autolytic debridement, stimulates growth of wound tissues and stimulates anti-inflammatory activities thus accelerates the wound healing processes. Compared with topical agents such as hydrofiber silver or silver sulfadiazine, honey is more effective in elimination of microbial contamination, reduction of wound area, promotion of re-epithelialization. In addition, honey improves the outcome of the wound healing by reducing the incidence and excessive scar formation. Therefore, application of honey can be an effective and economical approach in managing large and complicated wounds.

Wound Healing Society 2015 update on guidelines for pressure ulcers.

Wound Healing Society 2015 update on guidelines for pressure ulcers.

Debridement dressings

For any wound, necrosis is an obstacle to the formation of granulation tissue and creates an environment which is particularly favourable to the proliferation of bacteria. Mechanical debridement, carried out by a doctor or nurse, or surgical debridement, is usually necessary. It is completed by autolytic debridement using technical dressings. Among the many modern dressings designed on the principle of the moist healing environment, some are more adapted to the debridement phase and are recommended by the French National Authority for Health.

Wound Healing Society 2014 update on guidelines for arterial ulcers.

Wound Healing Society 2014 update on guidelines for arterial ulcers.

Efficacy of a superabsorbent dressing with Hydration Response Technology

Moderately and heavily exuding wounds are associated with delayed healing and an increased risk of infection. Elevated proteases found in chronic wound fluid keep a sustained state of inflammation. Superabsorbent dressings can absorb large quantities of exudate without losing their structure. Some are also able to bind and sequester proteases and bacteria within their structure. This article summarises the in-vitro and clinical evidence on the efficacy of Cutimed® Sorbion® Sachet S. The findings indicate that it helps facilitate autolytic debridement, absorbs exudate and reduces inflammation, and thus the risk of infection.

Debridement for venous leg ulcers.

Debridement for venous leg ulcers.

Modern and Convensional Wound Dressing to Interleukin 1 and Interleukin 6 in Diabetic wound

Introduction: Holistic wound care is one of the ways to prevent gangrene and amputation, modern wound dressing is more effective than convensional with increasing transforming growth factor and cytokine, especially interleukin. This study aims to identify the effectiveness of Modern and Convensional Wound Dressing to Interleukin 1 (IL-1) and Interleukin 6 (IL-6) in Diabetic wound.Methods:A Quasi eksperimental pre-post with control group design was used. The intervention given was modern wound dressing and Control group by convensional wound dressing, This study was conducted in Makassar with 32 samples (16 in intervention group and 16 in control group). Results: The result of Pooled T- test showed that p = 0.00 (p &lt; 0.05), it means that there was signifi cant correlation between modern wound dressing to IL-6 and IL-1 than Convensional wound dressing. Conclusion: Process of wound healing was produced growth factor and cytokine (IL-1 and IL-6), it will stimulated by wound dressing, modern wound dressing (Calcium alginat) can absorb wound drainage, non oklusive, non adhesif, and autolytic debridement.

New Twist on an Old Favorite: Gentian Violet and Methylene Blue Antibacterial Foams

Significance: Absorptive antibacterial dressings that assist in controlling bioburden without risks of cytotoxicity or residual absorption can be effectively used for prolonged periods throughout the wound healing continuum. Recent Advances: Until recently, gentian violet and methylene blue (GV/MB) antibacterial dressings have been commercially available only in polyvinyl alcohol (PVA) foam; polyurethane (PU) foam bonded with GV and MB with thin film backing is now commercially available. GV/MB PU foam does not require hydration or a necessary secondary dressing. GV/MB PVA and PU foam dressings were recently granted FDA clearance as antibacterial dressings, as opposed to bacteriostatic dressings as previously classified. Within the class of antibacterial dressings, GV/MB foam dressings are of lower cost alternative to silver- or iodine-based antibacterial dressings with no risk of absorption of any of the foam components into the tissues. Critical Issues: Control of wound bioburden levels by antibacterial agents and absorption of excess exudate are crucial in preventing infections that drastically increase the price of wound care. Use of GV/MB dressings may improve wound healing outcomes and decrease overall costs through super absorption, promotion of autolytic debridement, bioburden reduction, ease of use, and decreased dressing change frequency. Future Directions: Evolution in resistant bacterial strains will drive continual changes in advanced wound care products. Demand will increase for economically priced, versatile wound care dressings that assist in debridement, maintain a moist wound environment, absorb and trap bacterial debris, and decrease dressing change frequency.

Effects of Hypochlorous Acid Solutions on Venous Leg Ulcers (VLU): Experience With 1249 VLUs in 897 Patients

In order to assess the impact of comorbidities and identify factors that accelerate the healing rate of venous leg ulcers we performed an extensive, retrospective analysis of our experience in a diverse population. From June, 2006 to June, 2014, 897 patients with 1249 venous leg ulcers were treated at Lake Wound Clinics. Treatment protocols utilized the standard regimen of wound cleaning, debridement and compression bandaging. Wound cleaning, autolytic debridement, packing and dressing of venous leg ulcers utilized aqueous solutions of hypochlorous acid (HCA) rather than the standard normal saline. This protocol caused all ulcers to close completely. Comorbidities that delayed healing included uncontrolled or poorly controlled diabetes mellitus, advanced peripheral artery occlusive disease (PAD), active smoking, use of steroid medications and/or street drugs, large initial ulcer size and significant depth. Other factors, including advanced age, recurrent venous ulceration, stasis dermatitis, lipodermatosclerosis, morbid obesity and infection with one or more multidrug resistant organisms did not delay closure. From this experience we conclude that venous leg ulcer care protocols that clean, debride, pack and dress with hypochlorous acid solutions can reduce the effects of some comorbidities while accelerating healing times. Additional benefits are described.

Clinical evaluation of a thin absorbent skin adhesive dressing for wound management

This article assesses the use of BeneHold Thin Absorbent Skin Adhesive (TASA) wound dressings in a large UK primary care organisation. These wound dressings are thin (0.12 mm), breathable, transparent, and are able to absorb and retain wound exudate. This non-comparative evaluation was undertaken to explore the clinical advantages this differentiated combination of physical properties offered. The dressings are CE-marked medical devices, and were used on patients with acute and chronic wounds that were assessed and classified as light to moderately exuding. Clinical performance was evaluated with respect to the dressing's ease of use (application and removal, conformability, mould-ability, rolling and edge-lift), debridement, protection of the peri-wound, wear time, fluid handling, wound bed residue, visibility of the wound, and clinical acceptability. The evaluating clinicians used an agreed audit tool to collect data from case reports to document the progression of wounds of various aetiologies, including chronic and acute, for a maximum period of four weeks. Qualitative feedback on dressing performance was also collected at the evaluation's end, both from the clinicians' and patients' perspectives Results: Some 15 patients were assessed. The wear time was up to seven days in many cases, and on average was 3.9 days longer than their previous dressings. Clinicians perceived that wounds progressed toward healing in all but two cases, where the wounds remained unchanged. Out of five cases where wounds presented with necrosis, all underwent significant autolytic debridement underneath the new dressings. Transparency was a noted benefit from both the clinicians' and patients' perspectives because it enabled continuous monitoring of the full wound bed and peri-wound skin without the need to disrupt the dressing. The dressing was well-received by both clinicians and patients in all fifteen cases. The thin absorbent skin adhesive dressing was found to be a promising new technology that could offer significant advantages to improve the quality, cost, and convenience of wound care. Further work is underway to validate these findings in larger and more homogeneous patient groups.