Technology update Expert consensus on a new enzyme alginogel


Working in concert, these two enzymes, lactoperoxidase and glucose oxidase, form free radicals via hydrogen peroxide, which destroys the cell walls of adsorbed bacteria in a manner similar to our innate white cell defences[10]


. As


this is a selective process, only the absorbed bacteria are destroyed and not the essential regenerating cells of the healing wound.


Evidence Recent in vitro preclinical studies have demonstrated that low concentrations of this GLG-enzyme system kill antibiotic-resistant bacterial strains without being cytotoxic to fibroblasts and keratinocytes[2,3]


. Its mode of


action is summarised in [Fig 1]. The published clinical data include


studies on both acute and chronic wounds, for example, a 70-patient comparative study on partial-thickness hand burns[11] with venous leg ulcers[12,1]


, patients , and, an in vivo/in TIME component TIME


Wound bed disturbance


Tissue necrosis Barrier to further healing


vitro antimicrobial study on various chronic wounds with supporting cytotoxicity in vitro[2]


. In a retrospective study on two groups of


30 patients exhibiting burns, Hoeksema et al[13]


reviewed 10 years of clinical experience


with Flaminal. After stratifying burns treated with either


Flaminal or with silver sulfadiazine 1% cream according to depth, both superficial (p=0.013) and deep partial-thickness wounds (p=0.04) healed faster with Flaminal treatment — without the requirement for ancillary wound treatments. Recently, Durante[4]


published a report on


23 patients treated with Flaminal for up to 60 days. In this study, a mix of acute and chronic wounds were treated with Flaminal to control exudate and bioburden as part of the standard care protocol. Dressings were changed every 1–4 days according to the manufacturer’s instructions and/or clinical need.


Approach


Removal of necrosis (debridement) via: - Sharp debridement (surgical/bedside) - Wet-to-dry dressings - Hydrogels - Enzymes - Biosurgery - Negative pressure treatment.


TIME


Inflammation and infection Imbalance between microorganisms and host resistance, leading to delayed healing


TIME


Moisture imbalance Increased exudate resulting in increasingly wet wound and border maceration


Control of infectious agents: - Topical antibacterial treatment - Wet dressings with topical antiseptics - Iodophors - Tea tree oil-based products - Polyhexamethylene biguanide (PHMB) - Silver dressings - Sugar and honey.


Need for absorption of excessive fluid: - Alginates - Foam dressings - Hydrofibers - Super-absorbent filler dressings.


Need to protect wound borders TIME


Non-migrating wound edge


Surgical reconstruction Biologic wound dressings Skin-replacing biologic dressings


Table 1 Summary of the TIME model of wound care and the appropriate treatment approaches for each stage References


1. De la Brassinne M, Thirion L, Horvat LI. A novel method of comparing the healing properties of two hydrogels in chronic leg ulcers. J Eur Acad Dermatol Venereol 2006; 20(2): 131–35.


2 Vandenbulcke K, Laenen Horvat L-I, de Mil M, et al. Evaluation of the antibacterial action and toxicity of two new hydrogels: a pilot study. Lower Extrem Wounds 2006; 5(2): 109–14.


3 De Smet K, van den Plas D, Lens D, Sollie P. Pre-clinical evaluation of a new antimicrobial enzyme for the control of wound bioburden.Wounds 2009; 21(3): 65–73.


Page Points


1. Flaminal gel is designed for the management of exuding acute and chronic wounds, and bioburden control


2. A panel of international experts has recommended that it be designated an 'Enzyme alginogel' to reflect its composition


3. The panel has also reviewed all available evidence and has prioritised the use of Flaminal gels to four key functions: - continuous wound debridement - antimicrobial activity - maintenance of a moist wound healing environment


- protection of wound edges and epithelial cells.


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