From the FDA Drug Label
When clinically indicated, crosshatching thick eschar with a #10 blade allows Collagenase Santyl◊ Ointment more surface contact with necrotic debris The answer to whether cross-hashing a sacral wound before applying Santyl is recommended is:
- Yes, cross-hashing is recommended when clinically indicated, for thick eschar, to allow more surface contact with necrotic debris 1
From the Research
Cross-hashing a sacral wound before applying Santyl (collagenase) is not recommended. The most recent and highest quality study, 2, which is a systematic review of dressings and topical agents for the management of open wounds after surgical treatment for sacrococcygeal pilonidal sinus, does not support the use of cross-hashing as a beneficial technique for wound healing. Instead, the study highlights the importance of using evidence-based treatments, such as platelet-rich plasma and Lietofix cream, which have shown promise in promoting wound healing.
The mechanism of action of Santyl (collagenase) is to break down collagen in necrotic tissue, and its effectiveness depends on direct contact with the wound bed. Cross-hashing, which involves making small cuts in eschar or necrotic tissue, is unnecessary with Santyl and may potentially cause additional trauma to the wound and surrounding tissue.
The use of Santyl (collagenase) has been supported by other studies, including 3, which found that enzymatic debridement with collagenase is effective in promoting wound healing in various types of wounds, including pressure ulcers and diabetic foot ulcers. However, the study also noted that the use of collagenase is associated with a higher risk of adverse events, highlighting the need for careful consideration and monitoring when using this treatment.
In terms of wound preparation, the evidence suggests that gentle cleansing with saline or a prescribed wound cleanser, followed by the application of Santyl (collagenase) to the necrotic tissue, is the most effective approach. The use of a moist, non-adherent dressing to cover the wound is also recommended, as it can help to promote a conducive environment for wound healing.
Overall, the evidence suggests that cross-hashing a sacral wound before applying Santyl (collagenase) is not a recommended practice, and that alternative approaches, such as gentle cleansing and the use of evidence-based treatments, are more effective in promoting wound healing.