Types of Chronic Wounds: Indications for Enzymatic Débridement

Summary

The role of proteolytic enzymes in wound healing can no longer be seen as mere wound débridement Rather it should be considered as a single, but important player in the wound healing orchestra. Proteolytic enzymes are a family of proteins that serve to degrade necrotic débris derived from cell breakdown. They are produced endogenously often as precursor proteins whose activation is precisely regulated. These activated enzymes serve many functions in normal as well as pathological situations. In particular they are involved in the regulation of cell maturation and multiplication; collagen synthesis and turnover; celt deformation, migration and reepithelialisation; the development and removal of the perivascular fibrin cuffs found in venous insufficiency and leg ulceration, as well as the removal of dead tissues following inflammation. As a limited number of enzymes perform all these functions, it is difficult to predict the effects of applying synthetic proteolytic enzymes to a wound. Many such enzymes are currently commercially available and being promoted as alternatives to surgical wound débridement. It is important for their use to be considered in the context of their interaction with endogenous proteases, their physiological role in tissue, their ability to reach a desired target and the stage of wound healing at the time they are applied. Empirical observations and conventional wisdom however, support the view that sloughy wounds need to be débrided.