Can collagen help heal a surgical wound to close?

Collagen for Surgical Wound Healing

Collagen should not be used for the purpose of surgical wound healing as it has not shown significant benefits over standard care. 1

Evidence Against Collagen Use in Wound Healing

The International Working Group on the Diabetic Foot (IWGDF) strongly recommends against using collagen for wound healing with a strong recommendation despite low certainty of evidence 1. This recommendation is based on a review of 12 randomized controlled trials (RCTs) that showed no significant difference in wound healing or reduction in ulcer area when compared to standard care.

The evidence shows that:

• 9 out of 12 studies did not report any difference in wound healing or reduction in ulcer area at the end of study duration 1
• Any reported positive outcomes from the remaining studies should be treated with caution due to moderate or high risk of bias 1
• A 2012 study in rats found no statistically significant differences in maximum wound breaking strength between collagen-treated and saline-treated wounds at all time points up to 28 days 2

Standard of Care for Surgical Wounds

Instead of collagen, the following approaches are recommended for surgical wound care:

• Sharp debridement and basic wound dressings that absorb exudate and maintain a moist wound healing environment 1
• Appropriate wound closure techniques (continuous or interrupted sutures) based on the specific wound characteristics 1
• For skin closure, subcuticular continuous sutures may provide lower rates of superficial wound dehiscence compared to interrupted stitches (GoR 1B) 1

Special Considerations

While the general recommendation is against collagen use, there are specific situations where certain collagen-containing products have shown limited benefit:

1. A gentamycin-collagen sponge showed lower complication rates in the first month when used with primary closure in one study, though at 3 months the rates of recurrence and complications were similar 1

2. For diabetic foot ulcers specifically, consider sucrose-octasulfate impregnated dressing as an adjunctive treatment for non-infected, neuro-ischaemic ulcers that have had insufficient improvement with standard care for at least 2 weeks 1

Common Pitfalls to Avoid

1. Marketing claims vs. evidence: Despite aggressive marketing of wound care products including collagen, there is insufficient evidence supporting their routine use 1

2. Overreliance on case series: Some case series report positive outcomes with collagen products 3, but these are lower quality evidence compared to the RCTs that show no benefit

3. Confusing topical vs. systemic collagen: This recommendation applies to topical collagen for wound healing, not to systemic collagen supplements which have different indications

Conclusion

The current evidence does not support the use of collagen for surgical wound healing. Clinicians should focus on established wound care principles including proper debridement, infection control, appropriate dressings to maintain moisture balance, and standard closure techniques.