Serial Sharp Debridement and Formulated Collagen Gel to Treat Pressure Ulcers in Elderly Long-term Care Patients: A Case Study
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Index: Ostomy Wound Manage. 2013;59(11):43–49.
Clinicians treating pressure ulcers in the elderly in long-term care often face psychosocial, financial, and patient quality-of-life challenges; as such, they seek to identify products that meet wound healing goals as expeditiously as possible. The purpose of this case series was to evaluate outcomes of serial sharp debridement and the application of a formulated collagen gel in patients with chronic, nonhealing pressure ulcers. Three patients (two women ages 82 and 74 years of age and one man 82 years old, all incontinent of bladder and bowel with numerous comorbidities) had wounds >18 months’ duration on the buttocks or coccyx that failed to improve despite the use of a wide variety of treatments, including negative pressure wound therapy. All wounds were debrided at the start of treatment and weekly thereafter if necessary, followed by application of the collagen gel. The gel was covered with a sterile bordered gauze and, if needed, a semipermeable dressing. Dressings were left in place for up to 1 week. Two ulcers reepithelialized completely after 4 to 5 weeks of care, and the wound bed of the third ulcer was ready for grafting after 6 weeks of care. No adverse events occurred. Nursing staff appreciated the reduced dressing change frequency, although dressing maintenance remains challenging in patients with frequent incontinence episodes. Randomized clinical trials to evaluate the efficacy of this treatment approach compared to the use of traditional moisture-retentive dressings are needed.
Keywords: case study, pressure ulcer, long-term care, debridement, collagen
Potential Conflicts of Interest: Ms. Agosti received compensation for conducting the study and writing this manuscript from, and Dr. Chandler and Ms. Anderton are employees of, Cardium/Tissue Repair Company, San Diego, CA.
In many settings, including long-term care facilities (LTCFs), pressure ulcers are costly to treat, negatively impact the patient’s quality of life, are associated with increased morbidity and mortality, and require substantial resources for assessment and treatment.1
The most frequent site for pressure ulcer formation is on the lower part of the body, including over the sacrum, the back along the spine, the buttocks, the hips, and on the heels.2,3 Furthermore, the LTCF population is generally elderly and debilitated and incontinence is common, altering tissue tolerance to pressure.4 Based on clinician observation, this raises yet another challenge to treatment regimens — namely, the impracticality of products that are difficult to maintain due to incontinence and/or are very costly to reapply. Moist dressings and infection control are often the first line topical therapy in treating pressure ulcers.1,2 For non-responsive ulcers, negative pressure wound therapy (NPWT) is commonly employed as an adjunctive therapy,1,2 but its drawbacks include expense and incompatibility with some wound locations. If advanced wound care products could be used effectively by LTCF wound specialists, the cost of that care would be lower.
Collagen. Collagen plays an essential role in each phase of the normal wound healing cascade.5 One of collagen’s most important functions in wound repair is to provide a physical scaffold for cellular adhesion, migration, and proliferation. Type I formulated collagen gel (Excellagen®, Cardium/Tissue Repair Company, San Diego, CA) was cleared for marketing in 2011 by the US Food and Drug Administration (FDA) for use in the treatment of a variety of dermal wounds.