Examining the Effectiveness of Type 1 Activated Hydrolyzed Collagen in Wound Care

View more photographs featuring the wide variety of uses for Type 1 activated hydrolyzed collagen in wound care here: https://www.todayswoundclinic.com/slideshow/photo-slideshow-wide-variety-uses-wound-care-type-1-activated-hydrolyzed-collagen   Today’s marketplace offers wound care providers an extensive variety when it comes to utilization of collagen. The human body’s most abundant protein, collagen has been identified as having multiple functions in the healing process. The effective use of collagen in treating wounds is well established by numerous studies supporting its broad use. However, the functionality, efficiency, and effectiveness of respective collagens can be just as varied. This article provides an overview related to favorable wound care outcomes that have been experienced as a result of treating an assortment of chronic wounds with CellerateRX® collagen gel, as well as its cost-effectiveness. Each of the following four cases depicts the care rendered to patients who presented with chronic, nonhealing wounds and represents the versatility of the product, which produced quicker healing rates due to the benefit of collagen molecules that are a fraction of the size of native collagen and that bind with fibroblasts in the body immediately upon application.

Cases 1 & 2

  Patients cared for by Angela Savage, BSN, RN, MA, WCC, CWCA, AACCWS, DAPWCA, within the private practice of Steven Snively, MD, plastic surgeon, Parker, CO.   De-gloving Injury   In the case of avulsions, where an extensive area of skin is severed from the underlying tissue, CellerateRX has proven successful in healing the wound when other treatment efforts failed. A 54-year-old male suffered a forklift accident that resulted in an injury to his right lower extremity (RLE). He was treated for a de-gloving injury along with two fractures to the RLE. He received a skin graft to treat the injury. However, the graft had approximately a 60% take 30 days after the injury. The patient visited the clinic for a second opinion and was very adamant that he did not want another graft surgery. We created a POC where the inner and outer aspect of his RLE was treated with CellerateRX gel, which was applied twice per week and covered with a secondary dressing followed by a self-adherent wrap. Due to the simplicity of the CellerateRX application, the patient’s wife was able to conduct dressing changes and, therefore, the need for home healthcare was eliminated.   The expectations of the healthcare provider and the patient were exceeded, as the wound healing times were better than expected. The rate of healing not only saved the patient’s insurance provider thousands of dollars, it also provided an alternative to surgery. Total length of time from initial application to healed wound: 116 days.   Failed Skin Graft   A 64-year-old female had surgery to repair a ruptured Achilles tendon. During the two years following the procedure, the patient experienced multiple dehiscences and multiple episodes of yeast and thick, pseudomonas growth, along with chronic pain. Her wound comorbidities included diabetes, obesity, lower extremity edema, hypertension, failed skin graft in the Achilles area, and arthritis. Treatments for this patient included negative pressure, iodine gel, additional grafting, silver alginate, wound gel, cell matrix, and petroleum dressings.   At the time the patient presented to the clinic, the size of her wound was larger than during previous treatments, so her care plan was changed. The initial wound presentation was a reddish-pink, moist bed approximately 1.8 cm long and 1.3 cm wide, with a superficial depth. Given that the wound was two years old, some periwound discoloration was noted. The wound edges were treated with silver nitrate to jumpstart healing and foam dressing was applied. In addition, the caregiver applied CellerateRX gel 2-3 times per week. When the patient returned 30 days later, the wound was one-third in size and healing well. The same treatment regimen was prescribed. One month later, the patient presented with a healed wound area. CellerateRX was found to reduce office visits and the patient’s pain associated with the wound. Total length of time from initial application to healed wound: Approximately three months.

Cases 3 & 4

  Patients cared for by Alec O. Hochstein, DPM, DABPS, FASPS, AAPWCA, Great Neck, NY.   Diabetic Ulceration   The following case is an excellent example of the successful use of CellerateRX on a total contact cast (TCC) where the patient and provider had no access to the wound for a week or more at a time. Prior to referral, the patient presented to the hospital with ongoing complications including a deep infection of the right forefoot. The abscess required amputation of the digits, and the surgical site was left open to heal by secondary intention. The hospital treated the ulceration initially with sharp debridement, wet-to-dry dressings, and a surgical shoe. When the wound healing became stagnant, the patient was referred to the clinic.   The patient, a 46-year-old male, had an infected neuropathic ulceration of the right forefoot. Additionally, he presented with diabetic neuropathy, had a below-the-knee amputation of the contralateral limb, and multiple digital amputations of the affected limb comorbidities. The patient’s wound was moist, but would need to remain so underneath a TCC. The properties of CellerateRX gel would help donate moisture to the wound bed while encouraging autolytic debridement of the wound using the body’s own processes to promote healing.   The initial treatment included sharp debridement of the right foot wound. CellerateRX was applied topically, and the TCC was set in place on a fibrogranular wound base with serosanguinous exudate. This patient was seen on a weekly basis at the clinic for dressing and TCC changes. By the third week, sharp debridement of the wound was again used, and CellerateRX and the TCC were re-applied on a fibrogranular wound base with scant serous exudate. The wound showed significant improvement at this point. Note that there was no patient or family treatment during the intervening weeks. At five weeks, the same regimen was conducted with sharp debridement, application of CellerateRX, and a TCC. The healing was again measurably improved. The wound was smaller, with only a superficial depth. The wound base was granular and the exudate was still scant serous.   By eight weeks, the wound was nearly healed. The size was fractional. The wound base was epithelial, and there was no exudate. The patient received another sharp debridement, application of CellerateRX, and advanced to a custom-molded shoe instead of the cast.   In this case, the treatment was virtually carefree in between clinic visits. Total length of time from initial application to healed wound: 12 weeks.   Necrotizing Fasciitis   One favorable feature of CellerateRX is its ability to mitigate pain by protecting nerve endings. Use of the gel in drier wounds provides relief from pain and discomfort associated with dryness. Additionally, when a wound is weeping, infected, or fluid-filled, the CellerateRX powder can absorb up to 30 times its weight in exudate, likely resulting in a more comfortable treatment experience.   This patient was a 46-year-old male living with diabetes. His wound included right fifth-digit amputation and partial ray resection to surgically combat necrotizing fasciitis. The initial treatment included sharp debridement of the right foot wound edge. An application of CellerateRX gel, petroleum gauze, moist gauze, and a light compressive top-cover were applied over a granular wound base with the extensor tendon exposed and moderate serosanguinous exudate. At three weeks, sharp debridement was again used with the same application of CellerateRX gel and dressings. The wound size was noticeably smaller with decreased tendon exposure and scant serosanguinous exudate. At the seven-week visit, sharp debridement of the wound was repeated with the same gel and dressings. The size of the wound was improved, with only a superficial depth. The wound base was granular with no tendon exposure and scant serous exudate. Gel was applied every 2-3 days with the same layered bandaging throughout the treatment (in between sharp debridement sessions).   Necrotizing fasciitis is a challenging and difficult entity for the podiatric surgeon. This case was no different. Having a large amount of soft tissue loss and exposed tendons presented a unique challenge that needed to be addressed. In the past, hospitalization, as well as application of skin graft or skin graft substitute, would have been required. The ease-of-use of the CellerateRX activated collagen was the cornerstone of treatment. The gelatinous nature of the activated collagen was paramount in the ability to keep the exposed tendon and the structures moist to avoid desiccation and ultimate salvage of the patient’s limb function and appearance. Total length of time from initial application to healed wound: eight weeks.

Conclusion

  The authors believe the CellerateRX product has proven to have favorable results in significantly increasing healing times. In addition, the authors’ experience with this product would suggest that it decreases pain. While healing advanced wounds can be complex, the application of this product and its versatility when used in conjunction with other modalities allows it to be a first-line therapy in any wound care setting.   A biocompatible and biodegradable product that allows the clinician to use any other appropriate dressing and combine it with antimicrobials, CellerateRX has a recommended application of every 2-3 days, if necessary — a timesaver for those providers who conduct daily collagen dressing changes. In a budget-conscious environment, CellerateRX provides clinical efficacy while reducing overall cost of closing wounds. Many patients can require upwards of 15 products to treat the wound, but CellerateRX reduces this product need to two or three. The authors recommend this product for any wound care setting including podiatry, home health, long-term care, inpatient hospitals, and wound care clinics. Alec O. Hochstein is board certified in foot surgery by the American Board of Podiatric Surgery and maintains a full-time podiatry practice, Great Neck (NY) Family Foot Care. Angela Savage is a board certified wound and ostomy nurse and director of clinical services at the Center for Wound Healing and Hyperbaric Medicine, Swedish campus, Denver, CO. At the time of this study, she worked alongside Dr. Snively and continues to work with him in private practice. For more information, contact 888-830-3609 or sales@welldynehealth.com.