Effective wound healing and cost considerations dictate the dressing choice in the treatment of pressure ulcers. Graumlich and colleagues performed a study to compare hydrocolloid dressings with collagen in the healing of stage II and III pressure ulcers. Hydrocolloid is a moist, vapor-permeable, occlusive dressing used in wound healing. Collagen, extracted from bovine skin, enhances wound healing through a variety of probable mechanisms, such as angiogenesis, epithelialization, and granulation.
The investigators enrolled nursing home patients with stage II to III pressure ulcers in a single-blind, randomized trial, in which participants received collagen or hydrocolloid dressings, continuing treatment for eight weeks. The definition of complete healing was 100 percent epithelial coverage of the study ulcer, with the proportion of completely healed ulcers serving as the primary end point. Blinded observers used validated, standardized techniques to record ulcer length, width, and appearance.
The study population included 65 patients with a median age of 83.1 years. The treatment groups were similar in demographic and clinical characteristics. Complete healing rates were the same after eight weeks. For collagen patients, the mean healing time was five weeks, and for hydrocolloid patients, the mean healing time was six weeks. After multivariate logistic regression analysis, only ulcer depth remained a significant predictor of complete healing within eight weeks. Diabetes mellitus was not found to be associated with healing outcome (P =.858) in a post hoc analysis. A cost analysis showed that the average cost per patient with stage II or III ulcers was $222.36 for hydrocolloid treatment and $627.56 for collagen treatment.
There was a nonsignificant trend favoring collagen for healing ulcers deeper than 2 mm at baseline. Collagen treatment was more expensive and required more nursing interventions per week. The number needed to treat with collagen is 70 patients for up to eight weeks before one healing event will occur in patients who would otherwise receive hydrocolloid treatment.
The authors conclude that no differences could be detected between collagen and hydrocolloid treatment of pressure ulcers in treating stage II and III ulcers. Because depth appeared to be a predictor of healing, the authors suggest that further trials should compare efficacy of these agents in deep stage III ulcers.