Compression and Collagen Therapy for Wound Healing

What is compression therapy? 

Compression therapy is the primary model for the treatment of venous disease, including chronic venous insufficiency (CVI). Patients with chronic venous insufficiency have increased pressure in the deep veins of their lower legs due to faulty vein valves not being able to pump blood back to the heart.

As a result, blood pools in the legs, ankles, and feet. CVI can cause high resting pressure (almost double that of people with high-functioning veins), varicose veins, pain, swelling (edema), thrombosis, and venous ulcers. It may also lead to lymphedema, a condition characterized by the build-up of lymphatic fluids in the soft tissue due to a damaged lymph system.

Any instance of reduced circulation in the lower extremities can lead to venous ulcers. Ulcers may start as harmless abrasions, but the increased pressure in your blood vessels can adversely affect the tiny capillaries in the surrounding skin. As the skin becomes more fragile, your body may struggle to heal itself, leading to an ulcer.

Diabetic patients can also experience ulcers. Unmanaged blood glucous levels can damage blood vessels, decrease blood flow, slow healing, and allow small injuries to develop into diabetic ulcers.

Ulcers are “thickness wounds” and are categorized by the layers of skin they persist through. Depending on the severity of your ulcer, our doctors have several wound care options to choose from.

Compression therapy is one form of wound care that may speed ulcer healing. Generally, bandages or hosiery are placed over the wound site. The bandage pressure gently squeezes the leg, forcing blood back up toward your heart and preventing it from pooling in your lower extremities.

What are the benefits of compression therapy? 

The application of compression through bandages or stockings serves several purposes in the treatment of venous insufficiency. Compression therapy benefits include: 

• • Reduced blood vessel width
  • Improved blood circulation
  • Decreased fluid buildup (oedema)
  • Lower levels of inflammation

What are the types of compression therapy? 

UFAI’s healthcare team treats each patient as an individual. Our surgeon will select the best compression treatment for you to prevent complications such as skin irritation, discomfort, pain, and soft tissue or nerve injuries. We take a personalized approach to wound management.

Compression bandaging products are usually classified according to the level of compression at the ankle. For patients who do not have arterial disease, the pressure goal is about 40 mmHg at the ankle.

There are multiple treatment options we have access to at UFAI.

Short stretch compression bandages 

Short-stretch bandages are able to stretch to about 30-60%. They are very stiff and provide high compression.

Benefits of this type of compression include:

• • Firm support so calf muscles can push when walking
  • Low pressure when at rest
  • Reduced edema

It’s important to note that short-stretch bandages may need to be changed more frequently as swelling decreases and the limb becomes smaller.

Long stretch elastic bandages 

Long stretch bandages offer lighter compression and have higher extensibility, stretching to up to 300% of their original size.

Benefits of long-stretch bandages include:

• • Adaptable to the shape of the leg
  • High pressures are always sustained

This type of compression is usually used for patients with fixed ankles. However, it is not recommended for patients with arterial insufficiency. We can apply padding to improve compression comfort over bony prominences.

Multi-layer bandages 

A multi-layer compression bandage system provides effective compression through two or more layers of bandages of varying types. Multilayer compression can consist of an initial comfort layer against the skin, a second compression wrap, and a third layer of inelastic bandages to hold everything in place.

• • Spiral or figure-eight wrapping allows maintenance of the compression gradient for long periods at rest and when moving.
  • Requires less frequent changing, but units are less cost-effective.
  • Two-layer bandages have shown improved healing compared to single-layer bandages.

One potential downside to multi-layer compression is that it may alter your gait and restrict the ankle’s range of motion. You need to be extra careful to avoid falls.

Compression stockings 

Compression stockings should be worn once the venous leg sore has healed to prevent reoccurrence. Compression is available in socks, pantyhose, or tubular calf sleeves.

Collagen wound dressings and growth factor therapy 

Sometimes venous ulcer wound healing fails to progress. This is typically due to an extended inflammatory phase, often caused by increased matrix metalloproteases (MMPs) in the wound. Wound exudate is a clear mixture of fluid and white blood cells (leukocytes) that move to the wound to aid with healing and inflammation. Within these fluids are also various other proteins, such as MMPs.

MMPs are necessary to break down damaged tissue, but too many can destroy the healthy extracellular matrix (ECM) and impede wound healing. Bioburden, or the presence of biofilm in the wound, can also delay healing.

When tardy wound healing occurs, collagen dressings can restart dermal regeneration and speed healing.

What is collagen?

Collagen is the most abundant protein in the body and is the biological glue that supports cells. Collagen plays a significant role in all phases of wound healing, such as new blood vessel formation (angiogenesis), granulation tissue formation (the new pink connective tissue that indicates healing), wound debridement, and the wound's ability to re-grow tissue (epithelialization).

During healing, collagen stimulates immune cells and the cells that form connective tissue (fibroblasts). Additionally, it offers itself up to the MMPs so that they stop destroying new, healthy tissue that is trying to grow.

Collagen wound care products bind and inactivate MMPs. MMPs attack and break down collagen, so collagen dressings give these enzymes an alternative collagen source and allow the body’s natural collagen to be readily available for tissue growth during the wound-healing process.

While most individuals have enough natural collagen for wound healing, adding a boost of collagen to a wound dressing can shorten the time it takes for venous ulcers to heal.

Why collagen dressings for wound healing?

Collagen dressings support a moist wound environment while serving as a substitute for your body’s own collagen — thus speeding up the healing process. Collagen is often chosen as an “ideal” biomaterial for wound-healing dressings because it can accelerate wound healing and granulation tissue formation and reduce bacterial infection in chronic wounds. Collagen dressings can also be used to speed healing of surgical wounds and decrease the risk of complications.

A collagen matrix wound dressing contains collagen, calcium alginate, carboxymethyl cellulose (CMC), antimicrobials, and ethylenediaminetetraacetic acid (EDTA). They are often grafts taken from porcine, bovine, or avian sources.

Hydrogel collagen dressings, Promogran Prisma, and DermaCol are a few examples of commonly used collagen wound dressings. Each collagen therapy treatment bandage can have a slightly different makeup.

A bi-layered living cellular construct (BLCC) is composed of fibroblasts, keratinocytes, and bovine collagen. Alternatively, acellular fetal bovine collagen dressing (FBCD) is a bioengineered graft made solely from a bovine donor with all viable cells removed but the collagen left intact.

Collagen dressings are often a two-pronged approach

Collagen-based bandages used on hard-to-heal venous leg ulcers in conjunction with an absorbent secondary dressing under compression therapy have shown increased granulation tissue formation in the wound bed. Both in vitro and in vivo studies on the use of oxidized regenerated cellulose/collagen dressing have demonstrated their efficacy in modulating the microenvironment of non-healing wounds by restoring the balance between matrix metalloproteinases (MMPs). The use of collagen dressings in conjunction with other treatment modalities like negative pressure wound therapy (NPWT) can help facilitate adherence of the tissue layers in the wound bed and improve healing.

Using a collagen wound care dressing may stimulate healing in a stalled wound and reduce the wound size. Acceleration of wound healing in chronic or stalled wounds may also reduce overall wound care costs. Other management strategies considered can include silicone gels and sheeting, topical steroids, intralesional injections, radiation, laser therapy, and surgical scar correction.

Nevertheless, applying collagen at the onset of a full-thickness skin tear will increase healing rates. That’s why this has become the standard of care. After four weeks of treatment with the collagen matrix dressing, 68% of patients experienced wound closure, progressing to 73% at the final visit or eight weeks after the initial application.

Why trust your wound healing to UFAI? 

The podiatrists and surgeons at the University Foot and Ankle Institute have vast experience with all manner of foot and leg problems, including ulcers. In addition, we have ample experience with the latest procedures in managing symptoms and treating your pain, ranging from collagen wound dressings to VAC therapy for diabetic ulcers. 

For a consultation, please call (877) 736-6001 or make an appointment online now.

University Foot and Ankle Institute is conveniently located throughout Southern California and the Los Angeles area. Our foot and ankle surgeons are available at locations in or near Santa Monica, Beverly Hills, West Los Angeles, Sherman Oaks, the San Fernando Valley, El Segundo, the South Bay, LAX, Calabasas, Agoura Hills, Westlake Village, Valencia, Santa Clarita, and Santa Barbara.

 

Compression and collagen therapy FAQs 

 

What is the role of a collagen dressing? 

Collagen dressings help promote an optimal wound-healing environment. They can assist with inflammation, help prevent infection, slow the rate of scarring (fibrosis), and sometimes offer analgesic (pain relieving) properties. The collagen cells also help with new skin formation and blood vessel growth. 

 

What is the best way to treat venous leg ulcers? 

The gold standard of care for venous leg ulcers has long been compression therapy. Compression therapy has been found to speed healing and help prevent ulcers from returning. Collagen wound dressings combined with compression therapy can improve healing by encouraging tissue adherence in the wound bed. 

 

Are venous leg ulcers painful? 

Venous leg ulcer pain can feel like your legs ache, are heavy, or itch. Swelling can intensify sensations of pain, as can any infection that occurs in the wound. Pain can be acute or chronic and centralized in the ulcer, around the affected area, or elsewhere in the leg.

 

Sources:

Cazzell S. A randomized controlled trial comparing a human acellular dermal matrix versus conventional care for the treatment of venous leg ulcers. Wounds. 2019 Mar;31(3):68-74. 

Jones JE, Nelson EA. Compression hosiery in the management of venous leg ulcers. J Wound Care. 1998;7(6):293-6.

Valle MF, Maruthur NM, Wilson LM et al.. Comparative effectiveness of advanced wound dressings for patients with chronic venous leg ulcers: a systematic review. Wound Repair Regen 2014;22(2):193-204. http://doi.org/10.1111/wrr.12151