Claire Williams, Senior Wound Clinic Nurse, Medway Community Healthcare, Claire.williams102@nhs.net

Revamil Collagen is a Protease Modulating Matrix (PMM) dressing that reduces the protease and supports healing within the environment of the wound. Revamil collagen can be placed directly onto the open wound with little to no depth to donate collagen directly to the wound sight this, accelerates the closure of hard to heal wounds and encourages the growth of granulation tissue.

Diabetic patients form very poor collagen, and is often brittle therefore, wound healing can be very protracted. Adding collagen directly into the wound bed, donates collagen and helps with proteins that support the fibroblasts and repairing of the wound.

Mr K, a person with diabetes has been receiving treatment at a wound clinic for approximately two years. Due to complications with diabetes, Mr K was advised to have toe amputation. Post-surgery, followed by several skin grafts have left the stump wound with constant infection thus, delaying healing and closure. Mr K was receiving daily dressing changes within the wound clinic for over two years, the wound was stagnant and showing no sign of closure. 

Several antimicrobial dressings had been used to clear infection and close the wound. The wound, at times was responsive to dressings used however, a cavity remained unhealed and unresponsive. Revamil Collagen dressing was introduced to stimulate granulation tissue, reduce cavity size, and encourage wound closure. Mr K was fully compliant with using Revamil Collagen.  

Revamil collagen was used in the cavity, (see fig 1.) this measured 1.2cm, on this hard-to-heal stump wound. Within a week of using Collagen, (see fig 2.) the cavity closed to surface level and the Senior Wound Care Nurse commented that the granular tissue was the cleanest ever seen, (two years). The wound was evaluated and the decision to continue with Revamil Collagen was agreed as some granular tissue on the left upper side of the wound needed further treatment. 

Due to the nature of the wound being very wet thus, causing damage to the peri wound, Revamil balm was used to protect the surrounding skin, forming a natural barrier, preventing further break down and protection. Revamil Melginate impregnated with 100% medical grade honey was also used to manage and absorb high wound fluid levels, whilst donating antimicrobial properties. 

Prior to starting the Revamil dressing care plan, Mr K had developed severe osteomyelitis, and hospital admission was unavoidable for this complex wound. Within the Secondary care setting other dressings were used. Upon Mr K returning to the wound clinic slough was present within the wound, (see fig 3.) The left side cavity remains closed and Revamil Collagen, Melginate and balm have recommenced. Within a short time Revamil Melginate reduced the wound fluid and cleared the exudate from the wound site and Revamil Collagen and Revamil balm was applied daily.

Within four weeks of returning to the wound clinic and re-commencing Revamil Collagen, the wound is clearly reducing in size, ( see fig 4.) The tissue is very healthy and clearly visible to see. Due to such good progress with Revamil Collagen the team at the wound clinic reduced the dressing time change from once a day, to every other day. Mr K was very pleased with this outcome, for the first time in two years he did not have to come to the clinic everyday to have his wound attended to. This also impacted in a positive way on the wound clinic team, reducing the amount of nursing time for Mr K.

Revamil Collagen continues to be applied, every other day along with, Revamil balm around the wound edges. Unfortunately Mr K will have to undergo further amputation. The osteomyelitis is untreatable and after full assessment from Mr Ks Consultant has advised further amputation will be inevitable. The senior wound clinic nurse re-assessed Mr Ks wound and concluded, Revamil Collagen and Revamil balm continue, until amputation occurs. The rationale was the wound has, previously become re-infected, leading to hospital admission, further break down of the wound and Mr K has to return to the wound clinic for daily dressing changes. This care pathway has continued for three months and no re-infection has been reported, Mr K continues to be fully compliant, pain has been significantly reduced and the quality of life has improved greatly for this patient.