A new treatment for difficult wounds uses microspheres to accelerate healing. Professor Ralf Uwe Peter introduces an innovative therapy from Praxis Pharmaceutical that sets recalcitrant wounds on the road to healing.
The task of managing a hard-to-heal wound is a long and thankless one for patient and carer alike. After months, or sometimes years, of effort, it's easy to lose hope that a diabetic or leg ulcer will ever improve. Healthcare workers soon learn to be sceptical of the promises of innovative wound-healing products - which means that the discovery of a product that is truly effective inspires long-lasting loyalty.
Professor Ralf Uwe Peter, a wound-care specialist at Germany's Capio Blaustein Clinic and former president of the German Society of Wound Healing, has seen plenty of frustrating cases over almost 40 years in the field. His current work at the clinic often involves wounds that have resisted treatment for far longer than the four weeks considered standard for chronic wounds: many have existed for months, years or, sometimes, decades. As a veteran of the field, his expectations were not particularly high when he first came across PolyHeal.
Now distributed by Praxis Pharmaceutical, PolyHeal Micro - as it is now called - is an active wound-care product consisting of a liquid suspension of negatively charged, chemically inert microspheres. Used as an alternative or in conjunction with other wound therapies, studies have shown that it stimulates fibroblasts, keratinocytes and other cells to form granulation tissue and accelerate the healing process. Peter and his team trialled it on their worst cases - including diabetic ulcers and wounds with exposed tendons and bone. They had so far seen little response to treatments such as negative pressure therapy.
"We were very surprised to see that these wounds suddenly started to form granulation tissue," says Peter. "In some extreme cases, we could see a small growth of granulation tissue even on the tendon fascia."
The non-biodegradable microspheres are thought to encourage granulation by providing extra surface area for cells to grab on to and multiply. This eventually allows epithelialisation to begin so that healthcare workers have the option of using either a graft or secondary intention to finally close the wound.
"PolyHeal Micro conditions the surface of the periosteum or the peritendium so that granulation tissue can arise again and can start proliferating without being washed off," he explains. "The microspheres are small, but not small enough that they could be reabsorbed by normal tissue, so we have no toxic or pharmacological effect to fear when we apply it into the wound."
Peter and his team found that the treatment was effective even if dressings were only changed every two to three days, and regardless of the aetiology of the wound. It became a useful alternative to collagenase or silver dressings, as well as negative pressure therapy, particularly for outpatients - due to regulations, German clinics can only use negative pressure in an inpatient setting.
PolyHeal Micro can be applied directly to a clean and debrided wound quickly and easily due to its liquid form - without significantly increasing the workload for the healthcare worker or the discomfort of the patient. Peter finds it "very user-friendly", needing only the addition of gauze to hold the liquid in place within a wound.
The burden of a healthcare worker is sometimes increased rather than relieved when new treatments cause allergic reactions - further slowing down the healing process in patients whose immune systems are already compromised. However, Peter says this has never been an issue with PolyHeal.
"We have never seen any toxic or allergic reactions in relation to PolyHeal, so neither the fluids nor the particles themselves appear to induce allergic reactions," he says.
As a treatment, it seems very simple: PolyHeal Micro gives cells something physical to hold on to. But its effects go much further than the cellular level - it brings respite to some of the longest treatment journeys in healthcare.
"It's always quite frustrating to see the same patient for months and [find that] nothing really helps. And then suddenly, granulation tissue is flourishing: there is simply a lot of relief, not only on the side of the patient but also on the side of the therapists," Peter concludes. "In these cases, PolyHeal is an excellent option."