Lintzeris Dimitrios, Vernon Karen, Percise Heather, Strickland Andy, Yarrow Kari, White Amber, Gurganus Mary, Sherrod Susan, Vergin Kathleen, Johnson Laura
Wayne UNC Health Care's Wound Healing and Hyperbaric Center, Goldsboro, NC.
Wounds. 2018 Mar;30(3):72-78.
The management of chronic, nonhealing wounds in patients with multiple comorbidities continues to be a challenge for health care practitioners. Chronic wounds typically do not progress through the normal phases of wound healing and generally remain stagnant during the inflammatory phase, resulting in an increase in proteolytic enzymes with degradation of the extracellular matrix. Bacterial biofilm has been documented to be one of the main factors delaying wound healing, resulting in the prolongation of the inflammatory phase.
In order to control biofilm formation, sequester proteolytic enzymes, and provide a biocompatible scaffold to support healing, the investigators utilize a purified collagen matrix containing polyhexamethylene biguanide (PCMP) in a case series of 9 wounds on 8 patients with multiple comorbidities who did not respond to previous conventional or adjuvant therapy.
Wound etiologies included 3 pressure ulcers, 1 diabetic foot ulcer, 1 venous leg ulcer, 2 postsurgical wound dehiscences, 1 ulcer secondary to calciphylaxis, and 1 traumatic wound secondary to hematoma. The average wound size at the first PCMP application was 34.0 cm2, and the wounds were present for an average of 9.2 weeks prior to the first PCMP application.
Patients received an average of 5.8 PCMP applications. Of the 6 wounds that healed, average time to closure from the first PCMP application was 10 weeks. The remaining 3 wounds demonstrated improved wound appearance with 100% granulation tissue and an average area reduction during PCMP treatment of 61.4%.
This case series demonstrated that PCMP along with good wound care supported both wound closure and improvements in wound bed condition and area reduction on recalcitrant, nonhealing wounds of various etiologies.
对于患有多种合并症的患者，慢性难愈合伤口的管理仍然是医护人员面临的一项挑战。慢性伤口通常不会经历正常的伤口愈合阶段，在炎症阶段一般会停滞不前，导致蛋白水解酶增加，细胞外基质降解。细菌生物膜已被证明是延迟伤口愈合的主要因素之一，导致炎症阶段延长。
为了控制生物膜形成、隔离蛋白水解酶并提供生物相容性支架以支持愈合，研究人员在一个病例系列中，对8例患有多种合并症且对先前常规或辅助治疗无反应的患者的9处伤口使用了含聚六亚甲基双胍的纯化胶原基质（PCMP）。
伤口病因包括3处压疮、1处糖尿病足溃疡、1处下肢静脉溃疡、2处术后伤口裂开、1处钙化防御继发溃疡以及1处血肿继发创伤性伤口。首次应用PCMP时伤口的平均大小为34.0平方厘米，在首次应用PCMP之前，伤口平均已存在9.2周。
患者平均接受了5.8次PCMP应用。在愈合的6处伤口中，从首次应用PCMP到愈合的平均时间为10周。其余3处伤口在PCMP治疗期间伤口外观改善，肉芽组织达100%，平均面积缩小61.4%。
该病例系列表明，PCMP与良好的伤口护理相结合，可促进各种病因的顽固性难愈合伤口的闭合，改善伤口床状况并缩小面积。
