Collagen dressings gain favor among clinicians
Rapid ingrowth cited
Collagen, the body's most prevalent protein, is proving its merits as a wound treatment in theory and in practice. Long associated with the body's healing processes, collagen has become a treatment of choice for some wound care professionals.
Clinicians at the South Shore Wound Healing Center in Miami Beach, FL, rely heavily on collagen dressings, says Rebecca Guttermuth, RN, CWS, clinical nurse manager. "We've found collagen to be extremely effective," she says, summing up the clinic's experience.
Bovine-derived collagen came into favor at South Shore when the physician who set up its wound care program began using it with a few patients. Guttermuth says the physician had been working for years with growth factors, but abandoned them in favor of collagen when he noticed equal results at a lower cost.
"We were very impressed because we saw much of the same type of reaction in the wound as when we used [growth factors]: very rapid ingrowth of healthy beefy granulation tissue," Guttermuth says.
Treatment based on presentation, not etiology
Collagen is now the primary wound care modality used at the center, regardless of the wound type. Guttermuth reports using collagen dressings on pressure sores, ischemic ulcers, and diabetic ulcers. The treatment cannot be used immediately on wounds that present with dry eschar because such wounds require debridement for proper wound healing to occur. But once there is even a hint of granulation, collagen goes onto the wound, she says. "Wound etiology is not the deciding factor; the presentation of the wound bed is."
Guttermuth and her colleagues use either dry particles sprinkled on the wound, collagen gel, or collagen wafers. Collagen application often leads to transient redness and increased drainage, perhaps because of inflammation, and therefore should be covered with an absorbent secondary dressing. Guttermuth uses Adaptic (Johnson & Johnson), Vaseline Gauze (Sherwood), or Viscopaste (Smith & Nephew).
Collagen prices have dropped in recent years, according to Guttermuth, which makes it increasingly cost-effective. In addition, it appears to shorten wound-healing times. She says most wounds treated with collagen heal in 12 to 16 weeks, depending on original size. Wounds of long duration may take longer to heal.
A 'very user-friendly' treatment
Another cost advantage is gained by the fact that collagen usually requires dressing changes every other day, compared with some other treatments that require daily or twice-daily changes. Guttermuth calls collagen treatment "very user-friendly," because it can easily be applied in the home by patients or family members.
Kristen Cates, RN, BSN, account manager at Biocore Medical Technologies, which manufactures collagen for wound care in several forms (particles, wafers, pads, and gel), advises clinicians to make sure the collagen product they choose consists entirely of intact collagen. The triple-helical configuration of intact collagen allows it to interact with platelets, which help to stop bleeding, and to attract macrophages, which aid in wound debridement.
Several studies support the experiences at the South Shore Wound Healing Clinic. For instance, one 1993 investigation at the University of Modena in Italy involved 72 patients who had different types of skin ulcers (venous insufficiency ulcers, diabetic gangrene, radiation ulcers, pressure ulcers, burns, or post-traumatic wounds).
Heterologous lyophilized type I collagen sponge was compared with a dextranomer for wound healing time. In all cases, collagen-treated wounds healed faster than did those treated with dextranomer. The most outstanding results were obtained in the venous insufficiency group (32 days vs. 62 days healing time).
Another study, conducted a decade ago at Robert Wood Johnson Medical School in Piscataway, NJ, also showed collagen treatment in a favorable light. When type I collagen was applied to pressure ulcers, wounds decreased in size by 40% compared with those in the control group.
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