Oxidized Regenerated Cellulose/Collagen Dressings--An Adverse Event?

Oxidized, regenerated cellulose / collagen dressings with or without added silver are proven effective dressings in the treatment of all types of acute and chronic wounds.  These dressings have been shown to reduce the elevated protease and reactive oxygen species levels, improve the healing, and reduce the time to healing in chronic wounds.  (1)  These dressings reduce the bacterial burden of wounds and have been useful in the treatment of infected wounds. (2)  It has been recognized that the ORC portion of the product has hemostatic properties making the dressing helpful in bleeding wounds especially after sharp debridement. (3,4,5)  After treating numerous patients with the product, it was noted that a small percentage of patients complained of severe burning pain following application of the product.  The burning would last from 24 to 72 hours and could be so severe that the dressing had to be removed.  Research showed that as the ORC is broken down, it is converted into carboxylic acid with a significant lowering of the wound bed pH.  This change was responsible for its hemostatic and bacteriocidal effects. (6,7)  In an attempt to determine the cause of the patient’s reaction to the product, a series of 10 patients half of whom had a burning reaction to the product and half who did not was evaluated.  The wound pH was measured before application of the saline-moistened ORC/collagen dressing and after the product had been on the wound bed for 90 seconds.  In both groups of patients, the pre-application wound bed pH averaged 8.  90 seconds after application of the product the wound bed pH had fallen to and average of 6 in the patients who did not complain of burning, but it had dropped to an average of 4 in the patients complaining of burning.  Removal of the dressing in those complaining of burning resulted in an elevation of the pH to an average of 6 within another 90 seconds.  It appears the burning sensation experienced by certain patients is due to the lower acidic pH and its effect on the wound bed. The remedy will be discussed.

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References (if applicable): 1) Wu S, Applewhite A, Niegoda J, Snyder R, Shah J, Cullen B, Schultz G, Harrison H, Hill R, Howell M, Speyrer M, Utra H, de Leon J, Lee W, Treadwell T. Oxidizd Regenerated Cellulose/Collagen Dressings: Review of Evidence and Recommendations. Adv Skin Wound Care 2017;30:S1-18
2) Alfiieri S, Menghi R, et al. Role of Oxidized Regenerated Cellulose in Preventing Infections at the Surgical Site: Prospective, Randomized Study in 98 Patients Affected by a Dirty Wound. Minerva Chir 2011;66:55-62
3) Cheng W, He J, Wu Y, et al. Preparation and Characterization of Oxidized Regenerated Cellulose Film for Hemostasis and the Effect of Blood on its Surface. Cellulose 2013;20:2547-2558
4) Lewis K, Spazierer D, Urban M, Lin L, Redl H, Goppelt A. Comparison of Regenerated and Non-Regenerated Oxidized Cellulose Hemostatic Agents. Eur Surg 2013;45:213-220
5) Treadwell T, Alston J. Data on file. Institute for Advanced Wound Care, Montgomery, Alabama, 2019
6) Miller J, Jackson D, Collier D. An Investigation of the Chemical Reactions of Oxidized Regenerated Cellulose. Exp Med Surgery 1961;19:196
7) Spangler D, Rothenburger S, Nguyen K, Jampani H, Weiss S, Bhende S. In Vitro Antimicrobial Activity of Oxidized Regenerated Cellulose Against Antibiotic-Resistant Microorganisms. Surg Infect 2003;4:255-262