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Case Series/Study
Clostridium collagenases (CC) are a class of zinc-dependent metalloproteinases secreted by Clostridium histolyticum that play a critical role in selectively hydrolyzing denatured and necrotic collagen within a wound burdened with necrotic debris. These enzymes exhibit broad substrate specificity and are uniquely capable of cleaving the triple-helical regions of interstitial collagens under physiological conditions. Clostridium collagenase unwinds and hydrolyzes the triple-helical structure at multiple cleavage sites, leading to the disassembly of collagen fibers into smaller, soluble bioactive peptide fragments. This activity distinguishes clostridial collagenases from mammalian counterparts, which typically cleave collagen at a single site. These fragments may assist with the wound healing process to accelerate wound healing. Clinically, clostridium collagenase has traditionally been utilized in enzymatic debridement of dermal ulcers and burns. However, clostridium collagenase’s therapeutic properties go beyond solely being a debridement agent and provide a broader benefit to patients with complex wounds. Research shows that collagen fragmented byproducts produced via enzymatic digestion by the clostridium collagenase contribute to reduced secretion of pro-inflammatory factors and promote conversion of macrophages from a pro-inflammatory state to a pro-resolution state. Additionally, the data supports that collagen fragmented byproducts contribute to the migration and proliferation of fibroblasts, keratinocytes, & endothelial cells. Taken together, these factors contribute towards the formation of granulation tissue and subsequent epithelization.
Methods: We present a series of clinical cases showing complex wounds where CC was used beyond the endpoint of clinical debridement. Wounds were treated daily with FDA-approved clostridium collagenases ointment. Cases include: Non healing surgical wounds, TMA (2) abdomen (2). Non healing surgical wound back, Melanoma (1).
Results: In all cases Santyl was utilized beyond removal of necrotic debris. In all cases, the patients healed without surgical intervention. This secondary healing is remarkable in that the goal of Santyl typically is complete debridement.
Discussion: Understanding its catalytic mechanism has been essential for both therapeutic applications and insights into the benefits beyond debridement by clostridium collagenase. The denatured collagen fragments offer additional benefit following the debridement activity, which is clinically observed in this case series. Overall, the use of collagenase in complex wound management offers a biologically specific and cosmetically favorable alternative to traditional surgical approaches, contributing to better long-term aesthetic and functional outcomes in complex patients with complex wounds.