title: Randomised, controlled pilot to compare collagen and foam in stagnating pressure ulcers.
abstract: OBJECTIVE
  To compare the clinical efficacy of a collagen dressing covered with a foam dressing with the same foam used as a primary dressing in stagnating granulating pressure ulcer patients.
  
  
  METHODS
  Patients were randomised to receive either a foam dressing (Suprasorb P; Lohmann & Rauscher) as a primary dressing (group A), or a combination of a collagen dressing (Suprasorb C; Lohmann & Rauscher) covered with the same foam dressing (group B).Wound fluid was collected and evaluated prior to treatment (day 0), and on days 3,7, 14 and 21 .The level and expression of matrix metalloproteinases (MMPs) MMP-2 and MMP-9, and tissue inhibitors of metalloproteinases (TIMPs) TIMP- I and TIMP-2,as well as elastase content in wound fluid and angiogenesis,were evaluated, comparing results on day 0 and day 2 I.Time to ulcer healing, reduction in ulcer area, safety of treatment, patient-reported ulcer pain and comfort of the dressing regimen were evaluated as secondary outcomes. Patients received standard preventive measures, in line with the pressure ulcer prevention guidelines.
  
  
  RESULTS
  Ten patients were included in the pilot; five were treated with the foam dressing (group A) and five patients received the collagen dressing, using the foam as a secondary dressing (group B).Wound fluid from group B displayed a significant positive effect on angiogenesis (p < 0.05) compared with group A. In the collagen and foam groupTIMP- I and -2 increased faster and levels were higher than in group A. Furthermore, MMP-2, MMP-9 (p < 0.04) and elastase in group B showed faster and greater decrease in levels, compared with group A, indicating a faster and superior reduction of inflammation. In both groups the ulcers started to heal, with a faster onset of healing for group B.
  
  
  CONCLUSIONS
  The results of this pilot support published data on the use of collagen dressings compared with foam for stagnating wounds, shown in clinical studies.
  
  
  BACKGROUND
  This study was supported with an educational grant by Lohmann & Rauscher GmbH.Apart from DrAbel, the sponsors had no role in the design or conduct of the study, in the collection, analysis and interpretation of the data, or in the preparation, review or approval of the manuscript. DrAbel gave input to the study design from a scientific perspective. None of the authors received administrative, technical or material support for the conduct of this study.The authors have no other relevant financial interests to declare.
authors.affiliation: Department of Plastic Surgery and hand Surgery, Burn Unit, RWTH University Hospital Aachen, Germany. aoiatkowski@ukaachen.de
authors.forename: A
authors.initials: A
authors.lastname: Piatkowski
authors.forename: D
authors.initials: D
authors.lastname: Ulrich
authors.forename: D
authors.initials: D
authors.lastname: Seidel
authors.forename: M
authors.initials: M
authors.lastname: Abel
authors.forename: N
authors.initials: N
authors.lastname: Pallua
authors.forename: A
authors.initials: A
authors.lastname: Andriessen
mesh_terms: D000368:Aged; D001458:Bandages; D003094:Collagen / Q000627:therapeutic use*; D005260:Female; D005339:Fibrin Foam / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D003668:Pressure Ulcer / Q000188:drug therapy*; D011446:Prospective Studies; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D005339:Fibrin Foam; D003094:Collagen