Collagenase Ointment versus a Hydrogel Dressing for Treatment of Pressure Ulcers - Changes in Wound Surface Area

Background:
The effective treatment of pressure ulcers (PU) in long-term care (LTC) setting poses substantial difficulties for LTC providers. The removal of necrotic nonviable tissue is an essential component of proper wound bed preparation and a necessary prerequisite for PU epithelialization. Enzymatic and autolytic debridement are both frequently used in LTC settings and are considered safe, practical debridement methods. This study compares the clinical outcomes of the two debridement techniques.

Objective:
To compare the relative changes in wound bed surface area over time between pressure ulcer patients debrided with clostridial collagenase ointment (CCO) versus autolytic debridement with a hydrogel dressing in a long-term care setting.

Methods:
LTC patients with PU were randomized to receive daily dressing changes with either hydrogel or clostridial collagenase ointment (CCO). Both the hydrogel and CCO were covered with a standard semi-occlusive dressing. Changes in wound surface area (WSA) were assessed weekly for 7 weeks. A linear-regression analyzed the impact of time and treatment on wound bed progression.

Results:
Twenty-seven patients were enrolled in the study with 13 assigned to CCO enzymatic debridement and 14 to the hydrogel autolytic debridement. Both groups has statistically similar average WSA at baseline, 13 cm² for the CCO group versus 8cm² for the hydrogel group, respectively. At the 7 week end of study assessment only the CCO group demonstrated a statistically significant (p2 contraction per week.

Conclusion:
Patients treated with CCO achieved a statistically significant reduction in WSA over time compared to patients treated with a hydrogel dressing. This study supports the evidence base that enzymatic debridement provides a greater efficacy compared to autolytic debridement with a hydrogel when treating pressure ulcers in a LTC facility.