Elsevier

Burns

Volume 26, Issue 1, February 2000, Pages 54-62
Burns

Review
Collagen based dressings — a review

https://doi.org/10.1016/S0305-4179(99)00103-5Get rights and content

Introduction

Wound repair normally involves systematic, co-ordinated and balanced activity of inflammatory, vascular, connective tissue and epithelial cells [1]. The process of wound repair is orchestrated by the extracellular matrix [2], [3] while interleukins and other growth factors play a major role in the regulation of cellular processes. These intimately linked activities act as agonist/antagonist in their cellular effects [4]. Response to cytokines is related to the cellular constituents of the wound [5] their receptors and the extracellular matrix composition of the wound. A disturbance or aberration in these factors may lead to impaired or abnormal healing. In addition to the above features, wound healing is a highly complex process affected by factors that are specific to the individual such as nutritional status, age, systemic disease, medication, behaviour, etc., along with the size, depth, causation and etiology of the wounds [6].

The existence of a variety of wound types with varied healing modes and phases led to the evolution of different types of wound dressings. Wound dressings before the 1960s, were considered to be only passive products that had a minimal role in the healing process. The pioneering research of Winter [7] in the 1960s initiated the concept of an optimal environment for wound repair and the active involvement of a wound dressing in establishing and maintaining such an optimal environment. This awareness resulted in the development of wound dressings from the traditional passive materials to the more functionally active dressings which, through interaction with the wounds they cover, create and maintain a moist healing environment.

Traditional wound management involves disinfection, debridement and provision of a moist environment to encourage the establishment of the best environment for natural healing process. An ideal dressing may therefore, be characterized on the basis of its performances — criteria which include:

  • 1.

    Provision and maintenance of a moist environment;

  • 2.

    Wound protection from secondary infections by acting as a bacterial barrier;

  • 3.

    Provision of adequate gaseous exchange;

  • 4.

    Provision of thermal insulation free from particulate or toxic contaminants;

  • 5.

    Management of excess exudate by allowing non traumatic removal and

  • 6.

    Elastic and non-antigenic [8]

Burn wound dressings can be classified into two major categories according to usage [9], [10], [11], [12] as follows:

  • 1.

    Short term application dressings: These dressings require replacement at regular intervals

  • 2.

    Long term applications–skin substitutes — They can be further subdivided into:

    • 2.1.

      Temporary — Applied on fresh ‘partial thickness wounds’ until complete healing is ensured.

    • 2.2.

      Semi-permanent — Applied on ‘full thickness wounds’ until autografting.

However, the classification of dressings more frequently used is one based on the nature of its material rather than the mode of application. Based on the type of material used for the preparation of dressing they may be classified as conventional, biological and synthetic dressings. Within each category, the dressings may be further classified into:
  • 1.

    Primary dressing — A dressing in physical contact with the wound bed.

  • 2.

    Secondary dressing — A dressing that covers the primary dressing.

  • 3.

    Island dressing — A dressing that is constructed with a central absorbent portion surrounded by an adhesive portion.

Section snippets

Conventional dressings

These dressing materials are made up of fabric material such as gauze [13]. They provide little or no occlusion and allow evaporation of moisture resulting in a dry desiccated wound bed. Further, it has been observed that even 64 layers of gauze cannot prevent entry of exogenous bacteria into the wound [14]. This led to the origin of compound dressings such as Tulle gras which is a wide mesh gauze impregnated with medical grade paraffin. This results in a relatively non-adherent dressing.

Synthetic dressings

These dressings can be classified into:

Biological dressings

These are derived from natural tissues usually consisting of various formulations and combinations of collagen, elastin and lipid [10]. They are far superior to synthetic dressings [34] in that they

  • 1.

    restore a water vapour barrier and prevent dehydration of the wound;

  • 2.

    decrease evaporational heat loss;

  • 3.

    decrease protein and electrolyte losses in wound exudate;

  • 4.

    prevent bacterial contamination of the wound and hence protect the wound and patient from sepsis;

  • 5.

    permit less painful dressing changes;

  • 6.

    permit

Conclusions

The development of cultured epidermal grafts in conjunction with collagen matrix to treat patients with life threatening major burns is a technology with potential to produce the best wound dressing–repair materials carrying the patients own skin cells on a compatible and organized matrix.

Collagen based dressings may therefore be considered as having the potential to satisfy all the requirements of an ideal dressing in that they provide an environment at the surface of the wound in which

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