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Introducing Collagen to a Stalled Wound

Updated: Sep 3, 2019

Written by: Janis Harrison, RN, BSN, CWOCN, CFCN

Collagen is the main protein of the extracellular matrix (ECM) of the skin and plays a critical role in wound healing. It is the most prolific structural protein in the human body, making it important in all phases of wound healing.

Collagen helps attract cells such as fibroblasts and keratinocytes to the wound which helps with debridement, angiogenesis re-epithelialization.

Chronic wounds usually stall during the inflammatory phase due to an overabundance of matrix metalloproteinases (MMPs). MMPs play a role in breaking down the unhealthy ECM so that new tissue forms. However, if too many MMPs are present they can also destroy the healthy ECM which in turn delays wound healing and can cause an increase in wound size. Collagen dressings are used as a method to reduce protease levels in the wound and can bind the excess. MMPs provide an artificial means to boost the stalled wound.

Time to SIMPLIFY -- so what is collagen?

I don't know about you but reading about MMPs, ECM, Collagen, proteases, fibroblasts, etc bogs down my brain. I find it all difficult to make sense of what is actually taking place in the wound so I'd like to share the way I teach my patients how to understand their stalled wound and the important role collagen has in wound healing.

Think of the wound as a small puddle. Matthew, Mark and Paul (MMP) are called to the puddle to stomp out the fluid in the wound. But it rains and naughty children join in the puddle. Now, there are so many naughty children in the puddle stomping around that the puddle becomes a muddled puddle.

What needs to happen for this wound to heal?

We need to get the naughty children out of the puddle and get this puddle back to where it was just Matthew, Mark and Paul (MMP).

Time to call in Momma Protein (aka Collagen) to get the naughty children to go home and allow Matthew, Mark, and Paul to do the stomping.

Adding "Momma Collagen" allows the three boys to finish their job. The puddle gets smaller and dries up.

When should collagen be introduced?

Collagen dressings come in numerous forms (gels, pastes, polymers, and oxidized regenerated cellulose) and can be considered a native form It's time to add a collagen dressing when you see the wound has stalled. It's available in many forms and provides natural scaffolding for new tissue growth.

There are different levels of collagen found in the skin. Type I represents 77-85% of the collagen present in the normal human dermis. Collagen can be made up of different concentrations and types that can be found in bovine, porcine, equine and avian sources. The attributes given to each collagen dressing is to enhance the effects of the wound healing properties.

Examples of collagens on the market today include: Promogran and Promogran Prisma, Endoform, Epiona, DermaCol, Stimulen, Puracol, Triple Helix, Collasorb and more! View Halo's product list here.

Meet the Author

Janis Harrison, RN, BSN, C.W.O.C.N & C.F.C.N. is the owner of Harrison WOC Services, L.L.C. in Thurston, Nebraska. A graduate of Morningside College, Janis works as an independent contractor of Wound, Ostomy, Continence, and Foot and Nail Care services for medical entities throughout Northeast Nebraska. With over 30 years of experience as a nurse and 12 years as a CWOCN and CFCN, she found her passion for wound care when her spouse was afflicted with many complications from four consecutively failed surgeries that involved his ostomy. Through this experience, it became obvious that rural Northeast Nebraska was in need of wound and ostomy nursing care. After her husband survived an nine additional surgeries, Janis enrolled and graduated from the WOC Nursing program. Along with writing case studies, poster abstracts, newsletters, consulting with KCI and in-services, Janis has also helped to write and is the Chief Clinical Consultant of WoundRight, which is a documentation app available for tablets.

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