Non-surgical treatment of deep wounds triggered by harmful physical and chemical agents: a successful combined use of collagenase and hyaluronic acid.
Some chronic ulcers often occur with slough, not progressing through the normal stages of wound healing. Treatment is long and other therapies need to be performed in addition to surgery. Patients not eligible for surgery because of ASA class (American Society of Anesthesiologists class) appear to benefit from chemical therapy with collagenase or hydrocolloids in order to prepare the wound bed, promoting the healing process. We describe four cases of traumatic, upper limb deep wounds caused by different physical and chemical agents, emphasising the effectiveness of treatment based on topical application of collagenase and hyaluronic acid (HA) before standardised surgical procedures. We performed careful disinfection of lesions combined with application of topical cream containing hyaluronic acid, bacterial fermented sodium hyaluronate (0·2%w/w) salt, and bacterial collagenase obtained from non-pathogenic Vibrio alginolyticus (>2·0 nkat1/g). In one patient a dermo-epidermal graft was used to cover the wide loss of substance. In two patients application of a HA-based dermal substitute was done. We obtained successful results in terms of wound healing, with satisfactory aesthetic result and optimal recovery of the affected limb functionality. Topical application of collagenase and HA, alone or before standardised surgical procedures allows faster wound healing.
Department of Plastic, Reconstructive and Aesthetic Surgery, University of Rome La Sapienza, Rome, Italy.
Maria G
MG
Onesti
Department of Plastic, Reconstructive and Aesthetic Surgery, University of Rome La Sapienza, Rome, Italy.
Pasquale
P
Fino
Department of Plastic, Reconstructive and Aesthetic Surgery, University of Rome La Sapienza, Rome, Italy.
Ida
I
Ponzo
Department of Plastic, Reconstructive and Aesthetic Surgery, University of Rome La Sapienza, Rome, Italy.
Martina
M
Ruggieri
Department of Plastic, Reconstructive and Aesthetic Surgery, University of Rome La Sapienza, Rome, Italy.
Nicolò
N
Scuderi
D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D002648:Child; D017364:Collagenases / Q000627:therapeutic use*; D003646:Debridement; D004338:Drug Combinations; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000150:complications; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D006851:Hydrochloric Acid / Q000633:toxicity; D008297:Male; D054843:Negative-Pressure Wound Therapy; D009824:Ointments; D016038:Skin Transplantation; D013406:Suicide, Attempted; D014947:Wounds and Injuries / Q000209:etiology / Q000628:therapy*
D000276:Adjuvants, Immunologic; D004338:Drug Combinations; D009824:Ointments; D006820:Hyaluronic Acid; D017364:Collagenases; D006851:Hydrochloric Acid
Collagenase; Deep wounds; Hyaluronic acid; Wound debridement; Wound repair