A Randomized Controlled Study Evaluating the Clinical Benefits of a Cellulose Acetate Mesh Coated with a Soft Silicone in the Management of Acute Wounds.

INTRODUCTION: Dressings are a mainstay for wound management; however, dressing adherence to the wound or periwound area can cause pain and trauma at removal. Dressing-related trauma includes skin reactions, adherence to the wound, and skin stripping. The development of atraumatic wound contact layer dressings has been a major advancement in reducing trauma. OBJECTIVE: This study compares the benefits of a cellulose acetate mesh (CAM) coated with soft silicone versus a flexible polyamide net (FPN) coated with soft silicone. MATERIALS AND METHODS: A multicenter, randomized controlled study was conducted in 70 patients (35 in CAM group [1 patient exclused due to not receiving treatment], 35 in the FPN group) with traumatic, postsurgical, and burn wounds. Wounds were assessed once per week for 4 weeks to measure dressing adherence to the wound bed, percent reepithelialization, and patient tolerance. All wounds were prepared according to standard of care wound management protocol at the time of assessment. RESULTS: In this study, 97.06% (n = 33) of patients in the CAM group and 91.43% (n = 32) in the FPN group did not report dressing adherence during any of the assessments. Average time to complete reepithelialization was 16 days in the CAM group versus 15 days in the FPN group (P = .4958), and both products had excellent tolerance. CONCLUSIONS: This study demonstrated that CAM coated with a soft silicone performed as well as the FPN contact layer in minimizing dressing adherence, time to complete reepithelialization, and patient tolerance.

Randomized controlled trial on collagen/oxidized regenerated cellulose/silver treatment.

Collagen/oxidized regenerated cellulose (ORC)/silver therapy has been designed to facilitate wound healing by normalizing the microenvironment and correcting biochemical imbalances in chronic wounds. The aim of this study was to compare collagen/ORC/silver therapy to control (standard treatment). Patients with diabetic foot ulcers were randomized to either collagen/ORC/silver (24) or control treatment (15). Wound area measurements and wound fluid samples were taken weekly. Protease levels were measured in wound fluid samples to investigate differences between responders (≥50% reduction in wound area by week 4) and nonresponders (<50% reduction in wound area by week 4). There were significantly more responders in the collagen/ORC/silver group compared with the control group (79% vs. 43%, p = 0.035). There were significantly fewer withdrawals from the study because of infection in the collagen/ORC/silver group compared with the control group (0% vs. 31%, p = 0.012). The sum of matrix metalloproteinase-9 and elastase concentration was higher in nonresponders compared with responders at baseline (p = 0.0705) and week 4 (p = 0.012). The results suggest that collagen/ORC/silver normalizes the wound microenvironment and protects against infection, resulting in improved wound healing. It was also demonstrated that measuring a combination of proteases may be a more relevant prognostic healing marker than any individual protease alone.

An audit to assess the perspectives of U.S. wound care specialists regarding the importance of proteases in wound healing and wound assessment.

Chronic wounds represent an aberrant biochemistry that creates a toxic proteolytic milieu which can be detrimental to the healing process. Rebalancing the wound microenvironment and addressing elevated protease activity (EPA) could therefore help facilitate healing. To understand how clinicians currently diagnose and manage excessive proteolytic activity, 183 survey responses from US wound specialists were collated and analysed to find out their perceptions on the role of proteases. The majority of respondents (>98%) believed proteases were important in wound healing and that a point-of-care (POC) protease test could be useful. This study yielded a low response rate (7.1%, n = 183); however, there were adequate data to draw significant conclusions. Specialists perceived that fibrin, slough, granulation tissue and rolled wound edges could indicate EPA. About 43% of respondents, however, failed to give a correct response when asked to review photographs to determine if excessive protease activity was present, and the perceived visual signs for EPA did not correlate with the wounds that had EPA; no statistical differences between professions were observed. Respondents chose debridement, wound cleansing and advanced therapies as important in reducing excessive protease activity. It was concluded that specialists have a need for POC diagnostic tests. On the basis of the responses to wound photos, it was determined that there were no visual cues clinicians could use in determining excessive protease activity. Additional research is recommended to evaluate the efficacy of a POC diagnostic test for protease activity and the treatments and therapies applied when EPA is found.