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Antimicrobials are routinely used in the treatment of chronic and problematic wounds. Despite the on-going increase in numbers and types of products, well-designed clinical trials that support their efficacy are limited. Antimicrobial products are applied with understanding of their mechanisms of action and role in wound repair. This manuscript reviews the major categories of products on the market, providing the clinician with information on the different types of products and their purported effect on wounds. A new product containing polyhexamethylene biguanide is described in greater detail with relevant case presentations and cost data. This new product does not appear to have any known cytotoxicity in the dressing configuration and may be applied to a wide range of wounds.

Chronic wounds are characterized by failure in wound-healing response and a delay in healing or nonclosure of the wounds. This results in a high effort in clinical treatment and/or home care. A major difference between acute wounds and chronic wounds is the imbalance of proteinase inhibitors and proteinase activity that regulates the degradation and regeneration of the extracellular matrix proteins. Collagen and collagen/oxidized regenerated cellulose dressings act as a competitive substrate for matrix metalloproteinase-2, matrix metalloproteinase-9, and bacterial collagenase and influence this imbalance positively. Both wound dressings, approved for chronic wound treatment, the bovine collagen type I sponge and the oxidized regenerated cellulose collagen sponge, did not differ significantly in their sorption profiles for all enzymes. In general, binding was enhanced with a longer incubation time. The density of the device and the accessible surface, which can be controlled by the manufacturing process, are the crucial factors for the efficiency of the wound dressing.