Milne CT, Ciccarelli A, Lassy M, et al.
Wounds : a compendium of clinical research and practice. Date of publication 2012 Nov 1;volume 24(11):317-22.
1. Wounds. 2012 Nov;24(11):317-22.
A comparison of collagenase to hydrogel dressings in maintenance debridement and
wound closure.
Milne CT(1), Ciccarelli A(2), Lassy M(3).
Author information:
(1)Connecticut Clinical Nursing Associates, LLC, Plymouth, CT; email:
ccna2@juno.com.
(2)Federal Hill Plastic Surgery, Bristol, CT.
(3)Connecticut Clinical Nursing Associates, LLC, Plymouth, CT.
The role of maintenance debridement in wound healing has been well
described, yet little is known regarding comparative methods and associated
outcomes with this process when using collagenase or hydrogel.OBJECTIVE:
Evaluation of maintenance debridement and wound closure with collagenase compared
to hydrogel in institutionalized adults with pressure ulcers from time of
necrotic tissue removal up to 84 days from enrollment.
METHODS: This second phase of a rollover evaluation enrolled only subjects who
successfully completed phase 1 (previously reported) from time of necrotic tissue
debridement. Subjects received daily dressing changes with either hydrogel or
collagenase followed by a standard semiocclusive dressing to evaluate
wound-healing parameters and wound closure from initial enrollment to day 84.
Investigators blinded to randomization evaluated weekly wound photographs using a
digital planimetry software package for wound-healing parameters. Additionally,
Pressure Ulcer Scale for Healing (PUSH) © Tool and wound bed scores (WBS) were
monitored.
RESULTS: Eleven of 13 subjects from the collagenase group entered into phase 2,
with 4 of the 14 subjects from the hydrogel group. One subject from each group
was eliminated within the first week of phase 2. All subjects (n = 3) in the
hydrogel group reached complete epithelialization with a mean of 32.6 days. Nine
of 10 subjects in the collagenase group reached completed epithelialization with
a mean of 45 days. An independent samples t test showed no statistical
significance between the 2 groups (P = 0.121) in days to healing. A Fisher's
exact test performed on the primary endpoint of complete epithelialization also
demonstrated no significant difference in outcomes between the groups (P = 0.99).
Mean WBS at the onsetof phase 2 was 13.7 (range 12-16), and the PUSH Tool mean
score was 1.0 (range 0-3). In aggregating phase 1 and phase 2 data, a difference
in the closure rates at the end of the study, 69% (collagenase) vs 21%
(hydrogel), was statically significant (P = 0.0213) using a Fisher's exact test.
CONCLUSION: Facilitating maintenance debridement by either collagenase or
hydrogel can be used to complete wound closure when used in conjunction with a
validated predictive wound-healing tool that closely monitors therapy. This study
showed statistical significance in favor of collagenase when evaluating closure
rates from the onset of the pressure ulcer. .
PMID: 25876167
