Combining the Benefits of Collagen and Negative Pressure Wound Therapy to Heal a Chronic Diabetic Foot Ulcer

A Case Report

Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC

Disclosures

Wounds. 2020;32(3):E11-E13. 

In This Article

Abstract and Introduction

Abstract

Introduction: Diabetes affects 30 million children and adults in the United States, equivalent to 1 out of every 11 people in the country, and results in costs of $327 billion annually. Interventions that can improve healing rates and/or reduce the size of diabetic ulcers may lower the incidence of infection, rate of amputations, and cost of care. This report is on the use of a collagen wound contact layer in conjunction with negative pressure wound therapy (NPWT) to achieve healing in a chronic diabetic foot ulcer (DFU).

Case Report: A known patient with type 1 diabetes presented with a chronic DFU of 6 months' duration. Previous treatment modalities included offloading regimens and topical therapies (ie, clostridial collagenase, human platelet-derived growth factors, and 6 applications of a human amniotic membrane allograft). A collagen wound contact layer was applied to the debrided wound bed with subsequent debridements performed every other week, weekly NPWT dressing changes, and weekly contact layer changes. A 91% reduction in wound area was seen at day 35, with complete healing at day 63, and no recurrence at 18 months.

Conclusions: The combination of a collagen wound contact layer and weekly NPWT had a significantly positive effect on healing in this chronic DFU. The regimen was well-tolerated and simple to administer in this case.

Introduction

Diabetes affects 30 million children and adults in the United States, equivalent to 1 out of every 11 people in the country, and results in costs of $327 billion annually.[1] The International Diabetes Federation estimates 9.1 to 26.1 million people with diabetes will develop foot ulcers,[2] accounting for a lifetime incidence of about 19% to 34%.[3] In the United States alone, about one-third of the annual cost of diabetes care is related to lower extremity complications.[4] With the prevalence of diabetic foot ulcers (DFUs) on the rise,[1] the need for new and innovative tools to achieve healing in this class of chronic wounds has never been more pressing.

Collagen, the most common protein in the body and a key component of the wound healing process, is degraded by elevated protease levels within chronic wounds.[5] An application of a collagen wound contact layer to a wound bed introduces a sacrificial substrate, sparing the newly formed tissues and acting as a scaffold for the generation of new tissue.[6]

Negative pressure wound therapy (NPWT) is an adjunctive system that takes a biophysical approach to wound healing by creating subatmospheric pressure in the wound environment.[7] Using a vacuum-assisted closure device, negative pressure is induced in a controlled manner to remove excess fluids and increase blood flow to the area. This approach has been shown to be beneficial in the treatment of various wound types, including DFUs.[7–10] Similarly, collagen-based dressings also have been shown to be an effective tool for healing chronic DFUs.[11,12]

This case report presents the use of a collagen matrix wound contact layer (Figure 1; ColActive Transfer, Covalon Technologies Ltd, Mississauga, Canada) in conjunction with NPWT (V.A.C. Therapy; 3M+KCI, San Antonio, TX) to treat a chronic DFU nonresponsive to other advanced treatment options.

Figure 1.

Collagen matrix wound contact layer.

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