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Can we use Aquacel AG under Santyl for a wound dressing
Apr 13, 2018 by Andrea E., LPN,
4 replies
Samantha Kuplicki
MSN, APRN-CNS, AGCNS-BC, CWS, CWCN-AP, RNFA
Hi Andrea, to clarify, are you asking if you can apply Santyl to the wound bed for enzymatic debridement of nonviable tissue and cover with aquacel AG for absorption? The document below contains a table delineating the inhibitory action of wound dressings containing metals such as silver when used in combination with collagenase Santyl. Aquacel AG is listed as having an approximate inhibition of 7% when used in combination with Santyl. Santyl does somewhat rely on moisture to function adequately, so I would ensure the wound exudate is adequate for use of a hydrofiber over the Santyl.

Table 1
http://www.woundsresearch.com/files/wounds/WOUNDS_September2012_Shi.pdf
Apr 13, 2018
Nataliya Lebedinskaya
RN, BSN, CWOCN
When you using Santyl for debridement, best way to go is to cover Santyl with moist dressing and change daily. If you are looking for absorptive dressing on top to make less frequent dressing changes, you can use Aquacel Ag with no Santyl.
My favorite combination for debridement with no daily dressing changes is Iodosorb / Ca Alginate - debriding happening by decreasing bio burden, Ca Alginate for absorption - allows you to change dressing 2-3 times a week - preventing frequent wound exposure
Apr 13, 2018
Elaine Horibe Song
MD, PhD, MBA
Hi Andrea,
To complement the excellent answers provided by Samantha and Nataliya above, here is a link to an interactive tool on WoundReference that shows how various wound products affect collagenase activity. It's based on the article Samantha shared. In the silver dressing category Aquacel Ag doesn't seem to inhibit collagenase activity as much as Silvadene, but Algidex Ag is the most compatible one.

Enzymatic Activity of C. collagenase - Interactions
Aquacel Ag Foam with Silver
Algidex AG® Foam - Silver Alginate Foam Dressing
Apr 13, 2018
With regard to santyl, it is expensive and is a poor substitute for sharp debridement. It does require some moisture for activation so I was in the habit of putting hydrofera blue or plain aquacel over the santyl application. the dilemma is santyl requires more frequent applications then most of the products you might put over it to add moisture so it becomes a bit of a circus to coordinate and patients cant do it. I have all but abandoned the use of santyl. I will use Medihoney as it does have some autolytic debridement properties (not much). You might look into maggots as well, they work great but are a hassle to use. Ive had some patients show up with their own maggots (don't ask) which oddly was helpful but unreliable as a routine.
Apr 15, 2018
* Info provided without clinical evaluation and is not intended as a replacement for in-person consultation with a medical professional.