Collagen Dressing Selection to Re-Epithelialize a Stalled Wound

Introduction:

Moving a stagnant wound to closure is the challenge of all wound care clinicians. To address this problem, there is an increasing number of collagen dressings available in the market designed to help prevent and treat stalled wounds. A collagen dressing with an intact extracellular matrix (CECM) can help with closure by providing a natural substrate or scaffold for new tissue growth. In addition, published literature shows that a CECM can help reduce elevated activity of matrix metalloproteinases (MMPs) by redirecting the MMPs toward the dressing as opposed to the collagen that the body is trying to lay down. This key property can help propel a stagnant wound towards closure.

A common problem in the outpatient setting occurs when the chronic wound fills its defect with viable pink tissue, but final re-epithelialization is elusive. During an informal trial of two collagen dressings in an outpatient wound care setting, a noticeable difference was appreciated when looking at skin regeneration while directly comparing a dermal template derived from ovine collagen extracellular matrix with an equine Type I collagen. Repeatedly and in multiple types of wounds, skin regeneration progressed only when therapy was changed from an equine collagen to an ovine collagen dermal template. The reason for the difference in re-epithelialization using 2 different collagen dressings is unknown and warrants further study.

Conclusion:

This series of 3 case studies (a venous ulcer, a plantar aspect diabetic foot surgical wound and an abdominal surgical wound) demonstrated epithelial closure within 4 weeks of starting ovine collagen extracelluar matrix dressing after epithelialization stalled after 2 weeks or more of equine collagen therapy.  These cases can be generalized to aid in dressing selection when re-epithelialization is stalled in all types of wounds.