title: Use of collagenase ointment in conjunction with negative pressure wound therapy in the care of diabetic wounds: a case series of six patients.
abstract: BACKGROUND
  Diabetic wounds with additional comorbidities are costly, time intensive, and difficult to heal. Often, multiple modalities may be necessary to achieve wound resolution, relying on the synergistic advantage of each therapy to affect wound healing. The selectivity of Clostridium collagenase is physiologically effective at degrading non-viable collagen fibers while preserving living collagen tissue. Additionally, negative pressure wound therapy (NPWT) has long been used to aid wound healing while concurrently depreciating biological wound burden time.
  
  
  METHODS
  Six patients were selected from those appearing to our university based limb salvage service. Inclusion criteria included patients with a recurrent mixed fibrotic and granular wound base, in which NPWT was indicated, without exclusion criteria. Patients enrolled were administered clostridial collagenase ointment at each regularly scheduled NPWT dressing change. Patients were followed until healing, with visual representations of wound progression and time to full healing recorded.
  
  
  RESULTS
  Tandem application of these therapies appeared to expedite wound healing by clearing degenerative fibrous tissue and expediting wound granulation without additional complication. Unfortunately, not all patients were able to reach full healing; with two patients experiencing ulcer recurrence, likely a result of their significant comorbid nature.
  
  
  CONCLUSIONS
  In our experience, we have noticed a specific subgroup of patients who benefit greatly when collagenase enzymatic debridement therapy is combined with NPWT. It is our belief that this combination therapy combines the molecular clearing of non-viable collagen with the wound granulation necessary to advance complex wounds to the next step in healing despite the current paucity in literature discussing this specific pairing.
authors: Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA.
authors: John D
authors: JD
authors: Miller
authors: Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA.
authors: Elizabeth
authors: E
authors: Carter
authors: Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA.
authors: David C
authors: DC
authors: Hatch
authors: Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA.
authors: Michelle
authors: M
authors: Zhubrak
authors: Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA.
authors: Nicholas A
authors: NA
authors: Giovinco
authors: Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA; Armstrong@usa.net.
authors: David G
authors: DG
authors: Armstrong
keywords: collagenase; diabetes; negative pressure wound therapy; ulcers; wound healing
references: Wound Repair Regen. 2012 May-Jun;20(3):332-41
references: 22564228
references: Ann Plast Surg. 1997 Jun;38(6):563-76; discussion 577
references: 9188971
references: J Vasc Surg. 2010 Sep;52(3 Suppl):17S-22S
references: 20804928
references: J Wound Ostomy Continence Nurs. 2009 Nov-Dec;36(6 Suppl):S12-6
references: 19918145
references: Diabetes Care. 2013 Jul;36(7):1815-7
references: 23801792
references: Lancet. 2005 Nov 12;366(9498):1704-10
references: 16291063
references: J Wound Care. 2006 May;15(5):222-7
references: 16711179
references: Wound Repair Regen. 2009 May-Jun;17(3):306-11
references: 19660037
references: Diabetes Metab Res Rev. 2008 May-Jun;24 Suppl 1:S3-6
references: 18442166
references: Diabetes Care. 2013 Apr;36(4):1033-46
references: 23468086
references: JAMA. 2005 Jan 12;293(2):217-28
references: 15644549
references: Injury. 2009 Aug;40(8):801-5
references: 18703188
references: Int Wound J. 2010 Apr;7(2):87-95
references: 20529148
references: Dermatol Surg. 2001 Apr;27(4):347-51
references: 11298704
references: Wound Repair Regen. 2008 Jul-Aug;16(4):488-94
references: 18638266
references: Med Clin North Am. 2013 Sep;97(5):899-909
references: 23992900
references: Int Wound J. 2010 Oct;7(5):406-12
references: 20649833
references: Diabetes Care. 2008 Apr;31(4):631-6
references: 18162494
references: J Am Podiatr Med Assoc. 2008 Nov-Dec;98(6):489-93
references: 19017860
references: Am J Surg. 2008 Jun;195(6):782-8
references: 18355797
references: Ann Plast Surg. 2001 Nov;47(5):547-51
references: 11716268
references: Lancet. 2005 Nov 12;366(9498):1719-24
references: 16291066
references: Diabetes Care. 2004 Jul;27(7):1598-604
references: 15220234
references: Int Wound J. 2008 Jun;5(2):280-6
references: 18494633