Optimizing Wound Bed Preparation With Collagenase Enzymatic Debridement.

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.

Relative delivery efficiency and convenience of spray and ointment formulations of papain/urea/chlorophyllin enzymatic wound therapies.

OBJECTIVE: To determine the relative delivery efficiency and user preference for spray and ointment formulations containing papain, urea, and chlorophyllin copper complex sodium (papain/urea/chlorophyllin copper complex). METHODS: Participants applied both a spray and 3 ointment formulations of papain/urea/chlorophyllin copper complex to identical wound models. The average amount of product used per application was determined by weighing the bottle or tube before the study and after completion of the study. Participants were also asked to fill out a questionnaire regarding their preferences for the two formulations. RESULTS: The amount of product used per wound application was 30% less with the spray formulation; resulting in 29% more wound applications per container. Over 80% of the study participants found the spray easier and quicker to use than the ointments. CONCLUSIONS: The spray formulation of papain/urea/chlorophyllin copper complex resulted in less product use per wound application than did 3 different ointment formulations. Participants expressed a favorable impression of practical benefits of the spray formulation including a reduced risk of wound contamination.