Wound Chronicity: Collagen Promotes Reepithelialization

Chronic wounds are a constant source of frustration for individuals and health care providers all around the world. Lower extremity wound chronicity affects an amazing 4.5 million persons in the United States, whereas all sorts of chronic wounds afflict an estimated 1% of the Western population. The wound healing cascade does not always follow an ordered pattern of hemostasis, inflammation, proliferation, and remodeling.


Healing phases occur in an ordered and timely manner in an ideal wound environment (hemostasis, inflammatory, proliferative, remodeling). Chronic or difficult-to-heal wounds, on the other hand, do not heal, and the wound healing comes to a stop. Collagen is a unique triple helix protein molecule that forms a key segment inside the extracellular matrix and plays a critical function in every wound healing phase (ECM). Chronic wounds become “stalled” in the inflammatory phase, with an increase in proteolytic enzymes and extracellular matrix destruction (ECM). This wound environment becomes hyperinflammatory and proteolytic, preventing the wound from advancing farther along the wound healing timeline.


Clinical evidence suggests that collagen-based dressings may be capable of influencing wound biochemistry and addressing chronic wound imbalances. Consider the type and source of collagen, as well as the dressing’s characteristics, format, and bioactive technology, when choosing an advanced wound care collagen dressing.

Wound Care Products with Collagen

Collagen is the most prevalent protein in the body. Collagen helps wounds heal by attracting fibroblasts and encouraging the formation of new collagen in the wound bed. By accelerating the proliferation, migration, and differentiation of keratinocytes and restoring the protection of the underlying dermal structures, the reepithelialization process results in the development of new epithelium and skin appendages.

Collagen dressing technology encourages autolytic debridement, angiogenesis, and reepithelialization while stimulating new tissue growth. Excessive matrix metalloproteinases (MMPs) form in chronic wounds, interfering with the normal wound healing process. Excessive MMPs detected in the extracellular matrix are bound and inactivated by collagen dressings (ECM). Keratinocytes continue to proliferate around the margins of the wound and migrate to cover it until they meet in the middle. Some sources claim that well-approximated wounds can re-epithelialize in as little as 48 hours, while others claim that the process takes 2 to 3 weeks.

When the reepithelialization process fails, the wound and the patient may suffer undesirable consequences, such as the formation of a hypertrophic scar. It’s critical to reduce irregularities in the healing process in order to facilitate reepithelialization and wound closure. Many conditions, including those stated above, can produce wounds with poor reepithelialization, as well as diabetes, trauma, burns, bacterial infections, tissue hypoxia, local ischemia, exudates, and high amounts of inflammatory cytokines generating a continuous state of inflammation. A persistent state of inflammation may lead to an increase in cellular senescence and decrescence in the cell pool. What we do know is that MMPs must be present in the appropriate amount, at the right time, and in the right place for a wound to heal properly.

Collagen, especially types I and II, makes up around 70-80 percent of the ECM of skin. Collagen can come from any species, but it’s most commonly found in bovine, porcine, equine, Piscean, and avian tissues. Type I collagen is the most common of the three collagen types. It is the most often employed collagen in the wound healing process, accounting for more than 90% of the tissue. It can also be found in tendons, ligaments, bones, teeth, and scar tissue, in addition to the skin. At all anatomic sites studied, the application of bovine collagen matrix resulted in faster wound healing than typical second intention healing. The average time to complete healing using bovine collagen matrix was 6.1 weeks, compared to 9.4 weeks in the control group. The core collagen-based products of Human BioSciences, Inc. USA using a gentle manufacturing technique referred to as Kollagen Technology are made entirely of Type I bovine collagen in its purest form.

  • Medifil® II is Kollagen™ in particle form
  • SkinTemp® II is Kollagen™ in sheet form
  • Collatek® Gel is collagen in a viscous gel form

These dressings are suitable for granulating wounds with light to moderate exudate. Collagen dressings absorb excess fluid while maintaining a moist environment that promotes healing. Sheets, particles, amorphous gels, and pads are all options for collagen dressings.
Collagen acts as a template for future tissue formation in its matrix structure, and the primary structure continues to attract fibroblasts to the region. When the healing process reaches the maturation stage, it is thought to boost the deposition of orientated collagen fibers, which increases the new tissue’s tensile strength.
The goal of wound closure requires wound reepithelialization. The development of new epithelium and skin appendages is part of the reepithelialization process, which is a multifactorial systemic process. A number of variables might stymie the epithelialization process, all of which must be addressed before wound healing progresses. Excess matrix metalloproteases, impaired fibroblast signaling, ECM instability, and halted keratinocyte migration are all common stalling reasons.

When used in conjunction with wound bed preparation, moist-wound healing, offloading/redistribution, and education, different Collagen technology dressings have been found to advance chronic complex wounds towards the wound healing trajectory. When choosing advanced wound care products, healthcare providers should evaluate quality, product features, pricing, and availability.

References

  • Kolenik SA 3rd, McGovern TW, Leffell DJ. Use of a lyophilized bovine collagen matrix in postoperative wound healing. Dermatol Surg. 1999 Apr;25(4):303-7. doi: 10.1046/j.1524-4725.1999.08230.x. PMID: 10417587.
  • Brenner M, Albert P, Raminfard A. Collagen Treatment in the Diabetic Foot. The Diabetic Foot. 2019 November/December. Podiatry Management. https://podiatrym.com/pdf/2019/11/Brenner1119Web.pdf last accessed September 13, 2021.
  • Gibson DJ, Schultz GS. Molecular Wound Assessments: Matrix Metalloproteinases. Adv Wound Care (New Rochelle). 2013;2(1):18-23. doi: 10.1089/wound.2011.0359
  • Chattopadhyay S, Raines RT. Review collagen-based biomaterials for wound healing. Biopolymers. 2014;101(8):821-833. doi: 10.1002/bip.22486 Xenogeneic extracellular matrix as a scaffold for tissue reconstruction.
  • Badylak SF Transpl Immunol. 2004 Apr; 12(3-4):367-77. Westgate, S., Cutting, K. F., Deluca, G., &
  • Assad, K. (n.d.). Collagen dressings Made Easy (page 1 of 3) › Made Easy › Wounds UK. Retrieved September 13 ,2021 from http://www.wounds-uk.com/made-easy/collagen-dressings-made-easy.
  • Ayello E.A., Baranoski S., Kerstein M.D., Cuddigan J. Wound treatment options. In: Baranoski S., Ayello E.A., editors. Wound Care Essentials: Practice Principles. Lippincott Williams & Wilkins; Philadelphia, PA: 2003. p. 138 León-López A, Morales-Peñaloza A, Martínez-Juárez VM, Vargas-Torres A, Zeugolis DI, Aguirre-Álvarez G.
  • Hydrolyzed Collagen-Sources and Applications. Molecules. 2019;24(22):4031.Published 2019 Nov 7. doi:10.3390/molecules24224031
  • Fleck CA, Simman R. Modern collagen wound dressings: function and purpose. J Am Col Certif Wound Spec. 2011;2(3):50-54. Published 2011 Aug 1. doi: 10.1016/j.jcws.2010.12.003
  • V. R. Krishnaswamy and P. S. Korrapati, “Role of Dermatopontin in re-epithelialization: implications on keratinocyte migration and proliferation,” Scientific Reports, vol. 4, p. 7385, 2014.

Human BioSciences, Inc. blog offers education and tips; however,the information provided by this website or company is not a substitute for medical treatment or advice.

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