McCallon SK, Weir D, Lantis JC 2nd, et al.
The journal of the American College of Clinical Wound Specialists. Date of publication 2015 Aug 15;volume 6(1-2):14-23.
1. J Am Coll Clin Wound Spec. 2015 Aug 15;6(1-2):14-23. doi:
10.1016/j.jccw.2015.08.003. eCollection 2014 Apr.
Optimizing Wound Bed Preparation With Collagenase Enzymatic Debridement.
McCallon SK(1), Weir D(2), Lantis JC 2nd(3).
Author information:
(1)Department of Physical Therapy, Louisiana State University Health Sciences
Center, School of Allied Health Professions, Shreveport, LA, USA.
(2)Osceola Regional Medical Center, Kissimmee, FL, USA.
(3)Division Vascular/Endovascular Surgery, Division of Clinical Surgical
Research, Mt Sinai St. Luke's and Roosevelt Hospital Center, New York, NY, USA.
Difficult-to-heal and chronic wounds affect tens of millions of people worldwide.
In the U.S. alone, the direct cost for their treatment exceeds $25 billion. Yet
despite advances in wound research and treatment that have markedly improved
patient care, wound healing is often delayed for weeks or months. For venous and
diabetic ulcers, complete wound closure is achieved in as few as 25%-50% of
chronic or hard-to-heal wounds. Wound bed preparation and the consistent
application of appropriate and effective debridement techniques are recommended
for the optimized treatment of chronic wounds. The TIME paradigm (Tissue,
Inflammation/infection, Moisture balance and Edge of wound) provides a model to
remove barriers to healing and optimize the healing process. While we often think
of debridement as an episodic event that occurs in specific care giver/patient
interface. There is the possibility of a maintenance debridement in which the
chronic application of a medication can assist in both the macroscopic and
microscopic debridement of a wound. We review the various debridement therapies
available to clinicians in the United States, and explore the characteristics and
capabilities of clostridial collagenase ointment (CCO), a type of enzymatic
debridement, that potentially allows for epithelialization while debriding. It
appears that in the case of CCO it may exert this influences by removal of the
necrotic plug while promoting granulation and sustaining epithelialization. It is
also easily combined with other methods of debridement, is selective to necrotic
tissue, and has been safely used in various populations. We review the body of
evidence has indicated that this concept of maintenance debridement, especially
when combined episodic debridement may add a cost an efficacious, safe and
cost-effective choice for debridement of cutaneous ulcers and burn wounds and it
will likely play an expanding role in all phases of wound bed preparation.
DOI: 10.1016/j.jccw.2015.08.003
PMCID: PMC4566869
PMID: 26442207
