Comparative Study between Collagen Dressings and Conventional Dressings in Chronic Leg Ulcers

  • K Rojaramani1, S. V. Medical College, Tirupati, Andhra Pradesh, India.
  • G V Prakash S. V. Medical College, Tirupati, Andhra Pradesh, India.
  • G V Ramanaiah S. V. Medical College, Tirupati, Andhra Pradesh, India.
  • R Likhith Kumar S. V. Medical College, Tirupati, Andhra Pradesh, India
Keywords: Chronic leg ulcer, Collagen dressing, Efficacy

Abstract

Background: Chronic leg ulcer is defined as a non-healing or slow disintegration of epidermal and dermal tissue on the legs that last longer than 6 weeks. The majority of these ulcers are associated with venous disease, peripheral vascular disease, peripheral arterial occlusive disease, diabetes, nutritional factors, or metabolic factors like uremia. Collagen sheet is a material that is suitable for use as an allograft in wound healing. It is employed in sheets, membranes, and sponge forms; later, in preserved preparations, the material aids in the healing process by promoting regenerative healing while lowering scar formation through several properties such as physical, biochemical, and molecular biological pathways.
Materials and Methods: Study Design: A prospective follow-up study. Study Duration: One year from March 2, 2019, to March 1, 2020, at the time of Institutional Ethics Committee approval. Source of Data: Cases admitted in general surgery wards in S.V.R.R.G.G. Hospital, Tirupati. Sample Size: 100 patients.
Results: The mean rate of the percentage of reduction ulcer size was higher in the study group than in the control group. The Chi-square test results were analyzed, which showed a highly significant difference in the percentage of ulcer size (P < 0.0001). The total number of days in the hospital for the patient to stay is compared. The mean number of days of hospital stay in the control group was 18 days and that in the study group was 14 days. The results were analyzed by the Chi-square test, which showed a significant difference in the number of days of hospital stay. The total number of dressings required for complete wound healing with collagen dressing was 5.88 compared to conventional which was 11; t-test shows the significance. The rate of ulcer healing with the collagen group was 3.58 compared to the conventional group which was 4.66, t-test shows high significance.
Conclusion: Collagen dressing increases the rate of wound healing as compared to conventional dressings. Collagen dressings could be used to treat chronic non-healing leg ulcers.

Author Biographies

K Rojaramani1,, S. V. Medical College, Tirupati, Andhra Pradesh, India.

Associate Professor, Department of General Surgery

G V Prakash, S. V. Medical College, Tirupati, Andhra Pradesh, India.

Professor and Head, Department of General Surgery

G V Ramanaiah, S. V. Medical College, Tirupati, Andhra Pradesh, India.

Assistant Professor, Department of General Surgery

R Likhith Kumar, S. V. Medical College, Tirupati, Andhra Pradesh, India

Final Year Postgraduate MS, Department of General Surgery.

References

1. Sen CK, Gordillo GM, Roy S, Kirsner R, Lambert L, Hunt TK,
et al. Human skin wounds: A major and snowballing threat
to public health and the economy. Wound Repair Regen
2009;17:763-71.
2. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S,
Unwin N, et al. Global and regional diabetes prevalence
estimates for 2019 and projections for 2030 and 2045:
Results from the International Diabetes Federation
Diabetes Atlas, 9th edition. Diabetes Res Clin Pract
2019;157:107843. Available from: https://www.
diabetesresearchclinicalpractice.com/article/S0168-
8227(19)31230-6/abstract. [Last accessed on 2021 Jan 16].
3. Vibha SP, Kulkarni MM, Kirthinath Ballala AB, Kamath A,
Maiya GA. Community-based study to assess the prevalence
of diabetic foot syndrome and associated risk factors
among people with diabetes mellitus. BMC Endocr Disord.
2018;18:43.
4. Pontén B, Nordgaard JO. The use of collagen film (Cutycol)
as a dressing for donor areas in split skin grafting. Scand J
Plast Reconstr Surg 1976;10:237-40.
5. Tissue Repair-an Overview. ScienceDirect Topics. Available
from: https://www.sciencedirect.com/topics/medicineand-
dentistry/tissue-repair. [Last accessed on 2021 Jan 16].
6. Oyibo SO, Jude EB, Tarawneh I, Nguyen HC, Harkless LB,
Boulton AJ. A comparison of two diabetic foot ulcer
classification systems: The Wagner and the university
of Texas wound classification systems. Diabetes Care
2001;24:84-8.
7. Synthetic Wound Dressings, DermNet NZ. Available from:
https://www.dermnetnz.org/topics/synthetic-wounddressings.
[Last accessed on 2021 Jan 16].
8. Helimend Advanced Absorbable Collagen Membrane.
Available from: https://www.integralife.com/helimendadvanced-
absorbable-collagen-membrane/product/
surgical-instruments-miltex-instruments-veterinarymiscellaneous-
helimend-advanced-absorbable-collagenmembrane.
[Last accessed on 2021 Jan 16].
9. Povidone Iodine. Available from: https://www.pubchem.
ncbi.nlm.nih.gov/compound/410087. [Last accessed on
2021 Jan 16].
10. Chetan Samra. Antiseptic Soln. Health and Medicine
Presented at; UTC. Available from: https://www.slideshare.
net/drchetansamra/antiseptic-soln. [Last accessed on
2021 Jan 16].
11. Lazovic G, Colic M, Grubor M, Jovanovic M. The application
of collagen sheet in open wound healing. Ann Burns Fire
Disasters 2005;18:151-6.
12. Bao L, Yang W, Mao X, Mou S, Tang S. Agar/collagen
membrane as skin dressing for wounds. Biomed Mater
Bristol Engl 2008;3:044108.
13. Yazdanpanah L, Nasiri M, Adarvishi S. Literature review on
the management of diabetic foot ulcer. World J Diabetes
2015;6:37-53.
14. IWGDF-Guidelines; 2019. Available from: https://www.
iwgdfguidelines.org/wp-content/uploads/2019/05/
IWGDF-Guidelines-2019.pdf. [Last accessed on
2021 Jan 16].
15. Intravenous Insulin Therapy: Practice Essentials, Overview,
Key Components of Insulin Protocols; 2020. Available from:
https://www.emedicine.medscape.com/article/2049152-
overview. [Last accessed on 2021 Jan 16].
16. Manna B, Nahirniak P, Morrison CA. Wound debridement.
In: StatPearls. Treasure Island, FL: StatPearls Publishing;
2020. Available from: http://www.ncbi.nlm.nih.gov/books/
NBK507882. [Last accessed on 2021 Jan 16].
17. ShowText. Available from: http://www.bhjournal.in/
eJournals/ShowText.aspx?ID=1675 and Type=FREE
and TYP=TOP and IN= and IID=42 and Value=1 and
isPDF=YES. [Last accessed on 2021 Jan 16].
18. Rao H, Pai A, Hussein I, Arun A, Ram HS, Pai A, Pai SR,et al. A comparative study between collagen dressings and
conventional dressings in wound healing. Int J Collab Res
Intern Med Public Health 2012;4:1336.
19. Sood A, Granick MS, Tomaselli NL. Wound dressings
and comparative effectiveness data. Adv Wound Care
2014;3:511-29.
20. Frykberg RG, Banks J. Challenges in the treatment of
chronic wounds. Adv Wound Care 2015;4:560-82.
21. Krafts KP. Tissue repair. Organogenesis 2010;6:225-33.
22. Veves A, Sheehan P, Pham HT. A randomized, controlled trial
of promogran (a collagen/oxidized regenerated cellulose
dressing) vs standard treatment in the management of
diabetic foot ulcers. Arch Surg Chic Ill 1960 2002;137:822-
7.
23. Dhivya S, Padma VV, Santhini E. Wound dressings-a review.
BioMedicine 2015;5:22.
24. Singh O, Gupta SS, Soni M, Moses S, Shukla S, Mathur RK.
Collagen dressing versus conventional dressings in burn and
chronic wounds: A retrospective study. J Cutan Aesthetic
Surg 2011;4:12-6.
25. Chattopadhyay S, Raines RT. Collagen-based biomaterials
for wound healing. Biopolymers 2014;101:821-33.
26. Donaghue VM, Chrzan JS, Rosenblum BI, Giurini JM,
Habershaw GM, Veves A. Evaluation of a collagen-alginate
wound dressing in the management of diabetic foot ulcers.
Adv Wound Care J Prev Health 1998;11:114-9.
27. Di Mauro C, Ossino AM, Trefiletti M, Polosa P, Beghè F.
Lyophilized collagen in the treatment of diabetic ulcers.
Drugs Exp Clin Res 1991;17:371-3.
28. Treatment of Chronic Leg Ulcers with a Human Fibroblast-
Derived Dermal Substitute: A Case Series of 114
Patients. Wounds Research. Available from: https://www.
woundsresearch.com/article/2513. [Last accessed on
2021 Jan 16].
29. Braza ME, Fahrenkopf MP. Split-thickness skin grafts. In:
StatPearls. Treasure Island, FL: StatPearls Publishing; 2020.
Available from: http://www.ncbi.nlm.nih.gov/books/
NBK551561. [Last accessed on 2021 Jan 16].
30. Mir M, Ali MN, Barakullah A, Gulzar A, Arshad M, Fatima S,
et al. Synthetic polymeric biomaterials for wound healing:
A review. Prog Biomater 2018;7:1-21.
31. Rastogi S, Modi M, Sathian B. The efficacy of collagen
membrane as a biodegradable wound dressing material for
surgical defects of oral mucosa: A prospective study. J Oral
Maxillofac Surg 2009;67:1600-6.
Published
2021-08-10
Section
Articles