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A Journal on Physiopathology and Therapy of Chronic Cutaneous Ulcers
Official Journal of the Italian Association for Cutaneous Ulcers
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Acta Vulnologica 2011 December;9(4):173-81
Use of an absorbent non-woven fabric dressing based on benzyl ester of hyaluronic acid (Hyallofill®-F) in the treatment of difficult to heal ulcers of the lower extremities
Ambulatorio Ferite Difficili, Bentivoglio Geriatric Operative Unit, Bologna AUSL, Bologna, Italy
Aim. The healing of chronic wounds may be impaired even in the absence of acute circulatory changes or critical contamination and/or infection. Now, a new dressing based on Hyaff (benzyl ester of hyaluronic acid), a fundamental component of the extracellular matrix, is available. Wound exudate degrades Hyaff to form a gel that maintains a moist microenvironment, releases high amounts of hyaluronic acid and creates a substrate for tissue repair, thus providing the rationale for the use of Hyaff when repair processes seem to be “blocked”.
Methods. We evaluated the clinical effectiveness of Hyaff in 9 out-patients attending the Chronic Ulcer Clinic, Geriatrics Services, Bentivoglio Hospital, Bologna. During 6 weeks of follow-up, changes in wound presentation were recorded 5 times (T0, T7, T14, T28, T42) by measuring: 1) percentage of reduction in wound surface area; 2) speed of reepithelialization (calculated from the percentage change in wound area between T14 and T28); 3) presence of pain at dressing change (Numerical Rating Score).
Results. The application of a dressing containing Hyaff was followed by a reactivation of the healing processes, with complete healing of 4 wounds within 6 weeks of follow-up and within 97.6 days on average in the 5 remaining wounds. In our series the percentage change in wound surface area after 4 weeks of treatment was 62% on average, which was higher than the 50% change reported in recent reviews as a “clinically relevant” indicator of positive outcome. A significant change in pain scores in the intervals between medications was noted already at T14. The average pain score decreased to less than half the baseline value; pain nearly completely resolved by T28. The application of Hyaff did not incur an increase in the weekly cost of treatment.
Conclusion. Although the work did not include a randomized control group, the results suggest that hyaluronic acid is effective in both the reactivation of blocked repair processes and in relieving pain. Further studies, preferably of randomized controlled design, are needed to confirm these preliminary results.