From the Guidelines
Collagen dressings should not be used for wound healing of diabetes-related foot ulcers, as the current evidence does not support their effectiveness in this specific context. According to the guidelines on interventions to enhance healing of foot ulcers in people with diabetes (IWGDF 2023 update) 1, the evidence for using collagen or alginate dressings is considered moderate, and the strength of the recommendation is limited to conditional. However, the most recent and highest-quality study, which is the 2024 American Heart Association and American Red Cross guidelines for first aid 1, suggests that occlusive dressings, including collagen dressings, result in better wound healing than dry dressings.
When considering the use of collagen dressings, it's essential to weigh the potential benefits against the potential harms. Collagen dressings provide a scaffold for new tissue growth, promote faster healing, maintain a moist wound environment, and can absorb excess wound exudate. They are particularly effective for:
- Chronic wounds like pressure ulcers, diabetic foot ulcers, and venous leg ulcers
- Partial and full-thickness wounds
- Wounds with moderate to heavy exudate
- Granulating and epithelializing wounds
To use collagen dressings effectively, clean the wound thoroughly, apply the collagen dressing directly to the wound bed, and cover with an appropriate secondary dressing. Change the dressing every 1-7 days depending on the wound condition and manufacturer's instructions.
Collagen, the main structural protein in skin, provides a natural matrix for cell attachment and growth. When applied to wounds, collagen dressings:
- Attract fibroblasts and promote the deposition of new collagen fibers
- Maintain moisture while absorbing excess fluid
- Protect the wound from bacterial contamination
- Encourage the development of new blood vessels (angiogenesis)
- May bind and inactivate excess matrix metalloproteinases that can impair healing
However, in the context of diabetes-related foot ulcers, the current evidence does not support the use of collagen dressings, and other treatments may be more effective. It's crucial to consider the specific context and the most recent evidence when making decisions about wound care. In this case, the guidelines recommend against using collagen or alginate dressings for wound healing of diabetes-related foot ulcers 1.
From the Research
Importance of Collagen Dressing in Wound Healing
- Collagen is a key component of a healing wound, and collagen-based dressings play a crucial role in the wound healing process 2, 3.
- Collagen-based dressings can act as a 'sacrificial substrate' in the wound, addressing the issue of elevated levels of matrix metalloproteinases (MMPs) and promoting the formation of granulation tissue 2.
- These dressings can also absorb wound exudates and maintain a moist wound environment, which is essential for wound healing 2, 3.
Mechanism of Action
- Collagen dressings stimulate cellular migration and contribute to new tissue development, creating an environment that fosters healing 3.
- They can provide moisture or absorption, depending on the delivery system, and are easy to apply and remove 3.
- Collagen-based biomaterials can recruit specific cells, such as macrophages and fibroblasts, to enhance and influence wound healing 3.
Benefits of Collagen Dressings
- Collagen dressings can stimulate healing by manipulating wound biochemistry, and have been shown to be effective in promoting wound healing 3, 4.
- They can reduce the wound shrinkage rate and promote angiogenesis and granulation degree 5.
- Collagen-based nanofibers have demonstrated interesting properties, such as low antigenicity, good biocompatibility, hemostatic properties, and non-toxicity, making them suitable for skin regeneration and wound dressings 6.
Novel Collagen-Containing Dressings
- A novel collagen-containing polyester dressing has been developed, which exhibits a hydrophobic nature and prevents moisture from sticking to its surface 5.
- This dressing has been shown to have excellent hemostasis, regeneration, shrinkage reduction, and non-adhering properties, making it an ideal choice for wound dressings 5.