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Allows for autolytic debridement and gaseous exchange Can be left in place for 72 to 96 hours Foams Smith & Nephew Allevyn, Allevyn adhesive Beiersdorf Cutinova foam Carrington Carrasmart ConvaTec/CVL Hydrasorb J & J Nu-Derm, Tielle Kedndall Curaform Enzymatic Debridement Indications: A wound requiring debridement of fibrinous exudate, other necrotic material or slough Removes: Senescent fibroblasts - cant produce cytokines or collagen Necrotic tissue harboring bacteria Enzymatic Debridement Healthpoint ACCUZYME Papain (Papaya) digestant of nonviable protein Active over pH 3 to 12 Require stimulators: urea Solvent action on activators of papain, denatures non-viable protein May burn when applied APPLY DIRECTLY TO THE WOUND Irrigate out BID or QD May need to crosshatch eschar Enzymatic Debridement Healthpoint PANAFIL Indication: Granulating wounds with slough and infection Papain-urea proteolytic activity removes non-viable protein Chlorophyllin Copper complex-reduces fibrin formation Allows macrophages to arrive and signal fibroblasts Fibroblasts initiate collagen deposition Copper enhances structural integrity of deposited collagen Application: QD or BID, although 48 72 hour changes OK, can be applied under pressure dressings Combination Agents Healthpoint XENADERM Balsam Peru increases blood flow to wound site Castor oil creates moist wound environment Trypsin maintains clean wound bed Aluminum magnesium hydroxide stearate repels fluids BID for stage I and II wounds Antimicrobials Indications: Infected wounds, wounds with bacterial counts greater than 105 Bacterial count greater than this decrease wound healing rates Bacterial proteases degrade growth factors Therapeutic concentration at the site of the wound Antimicrobials Water-based topical antibiotics Penetrate granulation tissue Inhibit fibroblast growth Antimicrobials Silvedene Sulfamylon Acticoat Iodoflex Polysporin/Bacitracin Dakins Sulfamylon 5 % Sulfamylon cream (Mafenide Acetate, Bertek Pharm) Bacteriostatic vs

Using a BPC-157 results timeline helps track progress and ensures optimal outcomes

N Engl J Med 1994

Protein ranges should also be individualized