A Novel Enzymatic Debridement as Useful Tool for Tackling Hard to Heal Wound.pptx

enzymatic debridement

1. A Novel Enzymatic Debridement as Useful Tool for Tackling Hard to Heal Wound

2. Introduction

3. Wound Healing Wound healing is an intricate biological process of repair, which typically progresses through four overlapping phases This complex and fragile process is usually quite efficient, but is susceptible to interruption or failure that can result in non-healing / hard-to-heal wounds

4. Wound Healing Unlike wounds that typically heal within a reasonable timeframe, chronic or hard-to-heal wounds often contain a number of microbial, biochemical and cellular abnormalities that prevent or slow progression to healing, including necrotic tissue

5. Wound Healing Necrotic or sloughy tissue can harbor bacteria and act as a barrier to healing Debridement of sloughy/necrotic tissue is one of the cornerstones of good wound practice and vital when reducing the bacterial burden within the wound

6. Debridement – What, Why and When? Debridement is the removal of non-viable tissue from the wound bed to encourage wound healing Wound debridement is an essential part of wound care and its role in the preparation of the wound bed is well documented ( Falanga , 2001; EWMA, 2004; Wolcott et al, 2009)

7. Debridement – What, Why and When? Debridement is the removal of non-viable tissue from the wound bed to encourage wound healing Wound debridement is an essential part of wound care and its role in the preparation of the wound bed is well documented ( Falanga , 2001; EWMA, 2004; Wolcott et al, 2009)

8. Debridement – What, Why and When? For chronic (hard-to-heal) wound healing to occur, the wound environment must resemble that of a healing acute wound Reducing the bioburden and the presence of biofilms within the wound further inhibits the proinflammatory responses, encouraging formation of granulation Non-viable tissue and slough produces an abnormal wound environment that may interfere with wound healing. Debridement removes non-viable tissue to provide a wound environment that is less likely to support a heavy growth of bacteria.

9. Debridement – What, Why and When ? WHEN TO DEBRIDE? Debridement is indicated when there is a build up of necrotic tissue, callus, slough or other non-viable tissue in the wound bed Prior to debridement, it is important to recognize : types of non-viable tissue risk of the devitalized tissue the need of rapid debridement underlying comorbidities current patient status involvement of the multidisciplinary team

10. Method Explanation Advantages Disadvantages Surgical Uses a scalpel or other sharp instruments (scissors or curette) to remove devitalized tissue and accumulated debris (biofilm) Non-selective, invasive The most appropriate choice for removing large areas of necrotic tissue and is indicated whenever there is any evidence of infection (cellulitis, sepsis). Quick Can be combined with all the other methods of debridement during the perioperative period Can make the wound bigger Bleeding Possible general complications from the anesthesia. Mechanical Using mechanical force: wet-to-dry, pulsatile lavage, or wound irrigation. Non-selective Allows removal of hardened necrosis Inexpensive May be painful for the patient Contraindicated when in the presence of granulation tissue in a higher amount than the devitalized tissue, inability to control pain, patients with poor perfusion Enzymatic Applying exogenous enzymatic agents to the wound Selective : Collagenase digests the collagen in the necrotic tissue allowing it to detach A good option in patients who require debridement but are not surgical candidates They can be applied directly onto the necrotic area Highly selective process Reduce pain Slow method of debridement compared to mechanical or sharp debridement Not recommended for an advanced process, or in patients with known sensitivity to products ingredients Autolytic A natural process by which endogenous phagocytic cells and proteolytic enzymes break down necrotic tissue. Selective Requires a moist environment and a functional immune system. Highly selective process Reduce pain Slowest method of debridement The effectiveness depends on the amount of devitalized tissue to be removed as well as the actual wound size. Biological Sterile maggots (medical maggots) are placed directly on to the affected area and held in place by a close net dressing. The larvae have a ferocious appetite for necrotic material while actively avoiding newly formed healthy tissue Highly selective process Negative perceptions about its use by patients and care giver (larvae can escape the dressing) Reluctance from patients and clinicians

11. Debridement – Which one to choose? All methods require varying levels of expertise and have their advantages and disadvantages in terms of time taken, patient acceptability and ease of use It is important that the decision to debride and the method of debridement selected is the most effective for the patient, the amount of non-viable tissue to be removed and the anatomical location of the wound and should form part of the overall wound management plan for the patient.

12. Enzymatic Debridement Enzymatic debridement with collagenase is one of many techniques of debridement that is commonly used in clinical practice Enzymatic debridement is an active and selective approach to debridement often used in conjunction with other therapies, most commonly following sharp debridement in conjunction with moisture balancing dressings During this therapy, topical enzymes are used to remove necrotic tissue through the action of digesting and dissolving the devitalized tissue in the wound bed

13. Enzymatic Debridement Collagenase ointment is a theoretically selective enzymatic debriding agent derived from the bacterial strain It is characterized as selective because it specifically breaks down only one type of protein, collagen, an important component of the extracellular matrix whose selective degradation greatly facilitates healthy wound healing Collagenase has been demonstrated to be safe in wounds with high bacterial burdens

14. Enzymatic Debridement The most widely used collagenase preparation is derived from Clostridium histolyticum A novel collagenase-based ointment, derived from Vibrio alginolyticus , was tested Unlike the former collagenase preparation, this product contains hyaluronic acid which plays an important role in the wound healing process.

15. HYALO4 START The Novel Enzymatic Debridement

16. HYALO4START INGREDIENT Collagenase obtained from non-pathogenic Vibrio alginolyticus strain (not less than 2.0 nkat /g ointment) Sodium hyaluronate 0.2%

17. HYALO4START PRODUCT DESCRIPTION HYALO4START is a fluid ointment for topical use containing bacterial collagenase obtained from non-pathogenic Vibrio alginolyticus strain and sodium hyaluronate. HYALO4START allows the preparation of the wound bed, thanks to the hydrating properties of hyaluronic acid that promotes natural repair process while collagenase acts as enzymatic debridement for wound bed preparation

18. HYALO4START INDICATION Local management of chronic ulcers (i.e. pressure sores, vascular ulcers of the legs, diabetic ulcers). In particular, it is intended to provide an optimal moist environment and wound bed preparation that supports the natural healing process

19. HYALO4START DOSAGE & MODE OF ADMINISTRATION : The wounds should be cleaned before application. Apply a layer about 2 mm of HYALO4START on the wound once a day. Cover the treated area with sterile dressing to assure an appropriate contact

20. HYALO4START CONTRAINDICATIONS Patients with certain individual hypersensitivity to the product components must not use HYALO4START

21. HYALO4START ADVANTAGES : Allows the preparation of the wound bed More rapid wound bed cleansing and healing The absence of non-specific protease entails a totally specific action with no bothersome dermatitis around the wound Reduced pain referred by patients Very fluid, smooth and simple to apply; no discomfort nor pain for the patient

22. V. alginolyticus Week 0 Week 4 Week 8 C. histolyticum Week 0 Week 4 Week 8

23. This systematic review examines the effect of collagenase on all kinds of wounds, compared to an alternative therapy, on wound healing, wound bed characteristics, cost-effectiveness and the occurrence of adverse events

24. Collagenase appears beneficial for wound healing and for its ability to remove necrotic or devitalized tissues. Collagenase appears of interest postoperatively

25. HYALO4START In ulcers treated with V. alginolyticus-derived collagenase, a more rapid wound healing process was observed This result could be attributed to the presence of hyaluronan in the ointment composition. In fact, hyaluronan maintains an optimal moist environment and promotes the healing process , thereby reducing crusting, discomfort, erythema and swelling

26. HYALO4START The wound edges in patients treated with V. alginolyticus-derived collagenase were in better condition than the wounds treated with C. histolyticum-derived enzyme. There is a difference in aggressiveness between the two collagenases has been found in this study.

27. HYALO4START The V. alginolyticus enzyme is gentler on healthy tissue and allows an improvement of the surrounding skin. It can be speculated that the protective action is mediated by the presence of 0⋅2% hyaluronic acid in the product. In fact, hyaluronan allows the formation of the ECM matrix, promotes cell migration, modulates the inflammatory response and improves collagen deposition

28. Conclusions The ultimate aim of wound debridement is to obtain a clean healthy wound bed to allow rapid and effective healing. Debridement is often the first component of care in tackling hard-to-heal wounds Enzymatic debridement is a specific wound-debridement option using enzymes in ointments, can be useful in patients with wounds where surgical or mechanical debridement options are not available or are contraindicated HYALO4START, the novel enzymatic debridement with collagenase from V.alginolyticus , provides a highly selective debridement process, with additional benefits from the presence of hyaluronic acid to maintain moist wound environment and promote wound healing