A Comprehensive Review Of Topical Agents

By Jonathan Moore, DPM, MS, A. Patti Smith, MD, and John S. Steinberg, DPM

The wound is in constant evolution. Changes arise and you need to be able to respond accordingly in your treatment course. Indeed, understanding the biochemical dynamics of wound healing is vital for proper product selection (see “Understanding The Phases Of Wound Healing” on page 42). The challenge to the practitioner is to have the knowledge base with which to sort through the thousands of topical agents and dressings available today.

Insights On Topical Agents With Collagen
Let’s start out with a discussion of the biologic topical agents that contain collagen. Collagen hastens wound healing and works best when you apply it in the woven sheet format.
1. Kollagen (BioCore). These products are 100 percent non-denatured bovine collagen type I in proper configuration specific to skin tissue.
2. Medifil (BioCore). Of these products, you can use Medifil particles for draining, undermined, tunneled, infected or contaminated deep cavity wounds. Medifil pads are for deep cavity draining wounds. You may use Medifil gel to help treat dry, tunneled, superficial, minimally draining wounds.
3. Skin Temp (BioCore). Skin Temp (porous collagen sheets attached to a nonadherent backing) is also indicated for dry, superficial draining wounds.

4. Fibracol (Johnson and Johnson). Fibracol is a non-adherent, collagen-based dressing (90 percent) that is combined with calcium alginate (10 percent). It’s indicated for moderate to heavy exudative wounds, ulcers or dehisced incisions. It helps maintain a moist wound environment while allowing exudative transmission to prevent maceration.
5. Collagen Wound Gel (Johnson and Johnson). NU-GEL promotes natural autolysis by rehydrating and softening necrotic tissue while providing a moist wound environment.
6. Collagen Dressings. Another option is hyCure, a 96 percent type I collagen. It’s a hydrolyzed protein powder that forms a gel in the wound bed. It acts as a wound filler and exudate absorber.
7. Oasis (Healthpoint). Oasis offers a sterile wound covering to support tissue regeneration in partial thickness wounds. It provides a tissue-engineered collagen matrix derived from porcine small intestine submucosa (SIS). Oasis has a one-year shelf life and is available in single thickness, fenestrated sheets.

What About Hyaluronic Acid?
Hyaluronic acid is another biologic topical agent you should consider. Hyaff (ConvaTec) is an ester of hyaluronic acid (60 percent). As an essential component of the wound matrix, hyaluronic acid facilitates growth and movement of fibroblasts as well as controlling hydration. Use it for closure of sinuses and improved healing of indolent neuropathic ulcers. Hyalofill F is a non-woven fleece-like material. Hyalofill R is a rope-like material. You can use either of these as topical wound dressings, creating a hydrophilic gel rich in hyaluronic acid.

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