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Exudates from non-healing wounds contain elevated levels of proteolytic enzymes, like elastase from polymorphonuclear granulocytes (PMN elastase), reactive oxygen species (ROS) and reactive nitrogen species (RNS). The overproduction of proteolytic enzymes leads to reduced concentrations of growth factors and proteinase inhibitors, resulting in an imbalance between degradation and remodelling processes. Thus, the reduction of protein-degrading enzymes and scavenging of ROS and RNS seem to be suitable ways to support the healing process of chronic stagnating wounds. The aim of this study was to test selected wound dressings from different biomaterials (collagen, oxidized regenerated cellulose (ORC) and ORC/collagen mixture), regarding their antioxidative potential in vitro and their influence on the concentration and activity of PMN elastase in chronic wound fluid. Antioxidant capacity of the investigated wound dressing was determined by a pholasin-based chemiluminescent assay. PMN elastase concentration was determined by means of ELISA. Enzyme activities could be measured by a fluorescence assay. As the presented data demonstrates, all tested materials showed antioxidant capacity. In addition, the investigated materials were able to reduce the concentration and activity of PMN elastase. Beside other aspects, such as biocompatibility, biodegradability, fluid absorption and clinical effects (e.g. angiogenesis and microcirculation), the understanding of these properties may help to support the further refinement of wound dressings for improved wound healing.

Introduction:

Regarding the years of successful use Suprasorb® C of Lohmann & Rauscher (a special wound dressing composed of collagen type I), we performed a case study on nine patients with very large and mainly surgical wounds of a severe nature. The purpose was to demonstrate the effective and practical use of collagen dressings in these cases.

Methods

Descriptive investigation by determined criteria, put in a special form, was used to document the treatment as detailed as possible.

Results:

The average age of the patients was 60 years. Four of them had a postoperative wound disturbance in the abdominal area. A surgical removing of debris had been executed on 3 patients. Maggots were used on one patient to clean the wound area. In a single case honey and silver dressings were used to cure infections. Because of an extremely large wound in four cases, vacuum sealing was used to initiate wound closure. We used modern wound care products of the Suprasorb® line around the tenth day of treatment. In seven cases we applied firstly the alginate in order to clean the wound furthermore. We resumed treatment with collagen (Suprasorb® C) in all nine cases to accelerate the healing process of the wound. Foil and foam wound dressings were used additionally as secondary wound dressings to cover up the wound. Additional therapy was not necessary. The average wound surface at the beginning of the treatment was 101,5 cm2. At the end, it had been decreased to an average of 2,8 cm2 in 76 days, which meant a reduction of 97,2%.

Conclusions

Suprasorb® C is a patient-friendly and effective wound care product to heal secondary healing wounds eg severe surgical wounds. Further investigation concerning the duration of the wound healing process in comparison to conventional wound treatment is advisory.