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Comparative Study of Collagenase and Papain-urea Based Preparations in the Management of Chronic Nonhealing Limb Ulcers
The objectives of this study are to compare effectiveness of collagenase v/s papain- urea for debridement of chronic non-healing ulcers/wounds and to evaluate their role in promoting ulcer healing by granulation and reduction in ulcer/wound size. A comparative study of 100 patients was done at M.S. Ramaiah Hospitals in India from November 2007 to August 2009. Patients were selected, randomized, and divided into two groups consisting 50 patients each. Group- 1 treated with collagenase and Group 2 with papain- urea. Patients were evaluated at 0, 1, 2, 3, and 4 weeks for reduction in ulcer size, granulation, discharge and over all response to treatment. The mean age was 42 +/- 15yrs. The co-morbidities were diabetes 28.4 %, hypertension in 21.1%, others 14.0%. Culture and sensitivity test reveals that most frequently grown organism was E. coli (13%) Staphyloccus aureus (9%) and samples with no growth was 64%. In papain-urea group, ulcer was reduced from 24.8 sq. cms to 11.9 sq. cms and collagenase group 23.1 sq. cms to 9.7 sq. cms. There was significant reduction in slough and necrotic tissue i.e. in papain-urea group 22.54 sq. cms to 5.07 sq. cms and collagenase group 21.76 sq. cms to 6.12 sq. cms. Significant amount of increase in granulation tissue in papain-urea group i.e., 2.4 sq. cms to 6.82 sq. cms and collagenase group 1.4 sq. cms to 3.8 sq. cms was observed. But Papain-urea group showed better response in 2nd, 3rd, 4th weeks compared to collagenase (p value <0.05) and significant improvement in 28% in papain-urea, 12% in collagenase group. Mean follow-up period was 7.28- 8.14wks. Papain-urea and collagenase have shown proven efficacy in bringing out enzymatic wound debridement. Papain-urea is a better enzymatic debriding agent promotes faster granulation compared to collagenase.
Collagenase, Papain-urea, Non-healing Ulcer, Enzymatic Debridement, Debridement
- Altman MI, Goldstein L and Horowitz S (1978) An adjunct to healing trophic ulcerations in the diabetic patient. J. Am. Pod. Assoc. 68, 11-15.
- Alvarez OM, Fernandez-Obregon A, Rogers RS, Bergamo L, Masso J and Black M (2000) Chemical debridement of pressure ulcers: A prospective, randomized comparative trial of collagenase and papain/urea formulations. Wounds. 12 (2), 15–25.
- Berger MM (1993) Enzyme debriding preparations. Ost/Wound Manag. 39, 61–66.
- Falanga V (2002) Wound bed preparation and the role of enzymes: A case for multiple actions of therapeutic agents. Wounds. 14(2), 47–57.
- Gosiewska A, Yi C-F, Brown L and Geesin JC (1998) The effect of enzyme debriders on the biological activity of recombinant human platelet-derived growth factor-BB (rhPDGF-BB), the active agentofRegranex gel. Wound Rep. Regen. 6, A501.
- Herman I (1996) Stimulation of human keratinocyte migration and proliferation in vitro: Insights into the cellular responses to injury and wound healing. Wounds. 8, 33–41.
- Hobson D, White E, Anderson L and Lira L (1998a) Development and use of a quantitative method to evaluate the action of enzymatic wound debriding agents in vitro. Wounds. 10(4), 105–110.
- Hobson D, Lira L and Nijeha F (1998b) Evaluation of the effects of formulation factors on the action of wound debriding agents in vitro. Abstract presented at the 30th Ann. Conf. of the Wound Ostomy and Continence Nursing Soc. in Salt Lake City, Utah, June. 13–17.
- Levenson SM, Gruber DK and Gruber C (1981) Chemical debridement of burns: Mercaptans. J. Trauma. 21, 632–644.
- Miller JM and Howard F (1958) The interaction of papain, urea, and water-soluble chlorophyll in a proteolytic ointment for infected wounds. Surgery. 43, 939–948.
- Ramundo J and Gray M (2008) Enzymatic wound debridement. J. Wound Ostomy Continence Nurs. 35(3), 273–280.
- Rao DB, Sane PG and Georgiev EL (1975) Collagenase in the treatment of dermal and decubitus ulcers. J. Am. Geriatr. Soc. XXIII, 22–30.
- Steed DL, Donohoe D, Webster MW and Lindsey L (1996) Effect of extensive debridement & treatment of healing Diabetic foot ulcers. J. Am. Coll. Surg.183, 61-64.
- Stuart Enoch (2003) Wound bed preparation: The science behind the removal of barriers to healing. Wounds. 15 (7), 213-229.
- Westerhof W (1994) Futureprospects of proteolytic enzymes and wound healing. In: Proteolytic enzymes and wound healing. Westerhof W & Vanscheidt W (eds). Springer-Verlag & Co., NY. pp: 99–102.
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