Collagen in wound healing: Applications in modern medicine
Wound healing is an essential process that allows the skin and underlying tissue to recover after injury. In modern medicine, understanding this process is crucial to developing effective treatment strategies and avoiding complications such as infection or chronic wounds.
Overview of the role of collagen in the body
Collagen is the most abundant protein in the human body and forms the structural basis for skin, bones, tendons and ligaments. It gives tissue strength and elasticity and plays a central role in wound healing by serving as a scaffold for the formation of new tissue.
Basics of wound healing
Phases of wound healing
Wound healing takes place in several overlapping phases, each of which involves specific cellular and molecular processes:
Hemostasis phase
Haemostasis starts immediately after an injury to stop bleeding. Thrombocytes (blood platelets) aggregate at the site of the injury and form a temporary plug. At the same time, a cascade of coagulation factors is activated, which leads to the formation of a stable fibrin network that forms the basis for the subsequent healing processes. Collagen plays a decisive role here by supporting the activation of the thrombocytes and thus contributing to the formation of the fibrin network.¹
Inflammatory phase
During this phase, immune cells such as neutrophils and macrophages are recruited to the wound to eliminate pathogenic microorganisms and remove cell debris. Macrophages also release cytokines and growth factors that promote fibroblast proliferation and angiogenesis. Collagen fragments, especially type I and IV, act as chemoattractants for neutrophils and promote phagocytosis and the immune response.²
Granulation phase
The granulation phase is characterized by the formation of new connective tissue and blood vessels. Fibroblasts proliferate and synthesize collagen, especially type III, which serves as a temporary scaffold. At the same time, new capillaries sprout into the wound bed to ensure the supply of nutrients and oxygen. Collagen fragments, especially type I, promote angiogenesis by activating specific integrin receptors and recruiting endothelial cells.
Epithelialization phase
During this phase, epithelial cells migrate from the wound edge over the granulation tissue to close the wound. The synthesis of type I collagen increases, which helps to strengthen the newly formed tissue. Collagen serves as a scaffold for the migration of epithelial cells and supports the restoration of the skin barrier.⁴
Maturation phase
In the final phase of wound healing, the collagen network is restructured. Type III collagen is replaced by the more stable type I, and the collagen fibers orient themselves along the tension lines in order to increase the mechanical resilience of the tissue. This process can take several months to years. The tensility of the tissue improves, but rarely reaches the original strength of the uninjured skin.⁵
Factors influencing wound healing
Age and state of health
With increasing age, many regenerative processes in the body slow down, including wound healing. Among other things, this is due to reduced cell proliferation and collagen synthesis. In addition, age-related diseases such as diabetes mellitus or arterial occlusive diseases can further impair healing. A study from 2019 showed that inflammatory mediators such as TNF-α and IL-6 are increased in older people and have a negative impact on appetite and food intake, which in turn can delay wound healing.⁶
Diet and lifestyle
A balanced diet is crucial for effective wound healing. Proteins provide the necessary amino acids for the formation of new tissue, while vitamins and minerals such as vitamin C, zinc and iron act as cofactors in various phases of healing. A deficiency of these nutrients can significantly delay the healing process. A protein-rich diet of at least 1.0 g/kg body weight is particularly recommended for older people and patients with chronic wounds.⁷
Presence of infections or chronic diseases
Infections can significantly disrupt the healing process by increasing inflammatory reactions and inhibiting tissue regeneration. Chronic diseases such as diabetes mellitus lead to reduced blood flow and nerve function, which makes wound healing even more difficult. Effective control of blood glucose levels and appropriate wound care are therefore essential for healing in diabetic patients.
Collagen: structure and function
Structure and types of collagen
Collagen is the most abundant protein in the human body and forms the structural basis for skin, bones, tendons and ligaments. There are at least 28 different types of collagen, with types I, II and III being the most common. Type I is mainly found in skin, tendons and bones, type II in cartilage and type III in the skin and blood vessels. The collagen molecules consist of three polypeptide chains that form a triple helix and thus ensure high tensile strength.⁸
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Role of collagen in tissue formation
Collagen not only provides structural integrity to tissue, but also plays an active role in cell migration, differentiation and the healing process. During wound healing, it serves as a scaffold for cell proliferation and the formation of new extracellular matrix. A sufficient collagen content is therefore crucial for effective tissue regeneration.
Types of collagen wound dressings
Collagen films
Collagen films are thin, flexible layers of collagen that are applied directly to the wound. They serve as a physical barrier that prevents the penetration of bacteria while maintaining a moist wound healing area. Thanks to their transparency, they allow easy wound inspection without removing the film. These properties promote cell migration and support the formation of granulation tissue.¹¹
Collagen gels
Collagen gels are moist, viscous substances that are applied to the wound. They provide moisture, which is particularly important for dry or necrotic wounds. Hydration promotes cell migration and accelerates healing. Collagen gels can also modulate the activity of matrix metalloproteinases (MMPs), which supports wound healing.
Collagen pads
Collagen pads are thicker, absorbent dressings that absorb excess exudate and simultaneously supply the wound with collagen. They are particularly suitable for moderately to heavily exuding wounds and provide good padding. Through the continuous release of collagen, they support cell proliferation and promote the formation of new tissue.¹²
Collagen particles
Collagen particles are small, granulated forms of collagen that are introduced into deep or irregular wounds. They fill the wound cavity, promote the formation of granulation tissue and support healing in difficult areas. Their structure enables an even distribution in the wound bed, which facilitates cell migration.¹³
Mechanisms of collagen action in wound healing
Promotion of cell proliferation and migration
Collagen serves as a scaffold for the cells and supports their movement and proliferation. Collagen type I in particular attracts fibroblasts, which are responsible for the formation of new tissue. This accelerates healing and improves the quality of the regenerated tissue.¹⁴
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Support of angiogenesis
The formation of new blood vessels is crucial for supplying the healing tissue with nutrients and oxygen. Type I collagen promotes angiogenesis by attracting endothelial cells and stimulating their growth. This occurs through the release of growth factors such as vascular endothelial growth factor (VEGF).¹⁵
Modulation of the inflammatory response
A balanced inflammatory process is essential for healing. Collagen can help regulate the inflammatory response by influencing the activity of matrix metalloproteinases (MMPs), which are responsible for the breakdown of tissue. By inhibiting excessive MMP activity, the integrity of the newly formed tissue is protected.¹⁶
Stimulation of the body's own collagen synthesis
Collagen wound dressings can stimulate the body's own production of collagen. This is done by providing amino acids and other building blocks that are necessary for collagen synthesis. A sufficient collagen content in the wound area is crucial for the formation of stable and functional tissue.¹⁷
Clinical applications of collagen wound dressings
Treatment of chronic wounds
Diabetic foot ulcers
Diabetic foot ulcers are a common complication of diabetes mellitus. A study showed that the use of collagen wound dressings significantly increases the healing rate and shortens the healing time. Patients treated with collagen achieved complete healing in 82.4 % of cases compared to 38.5 % in the control group.¹⁸
Decubitus ulcers (pressure sores)
Pressure ulcers are caused by prolonged pressure on certain areas of the body, especially in immobilized patients. Collagen wound dressings promote the formation of granulation tissue and support healing by maintaining a moist wound environment and promoting cell migration.
Ulcus cruris (open leg)
Ulcus cruris, often caused by venous insufficiency, benefits from the application of collagen wound dressings. These support healing by modulating the inflammatory response and promoting angiogenesis. Studies show that the combination of collagen dressings with compression therapy improves healing rates.
Use for acute wounds
Surgical incisions
After surgical procedures, collagen dressings can support the healing process by promoting cell proliferation and reducing the risk of infection. Their use can minimize scarring and accelerate healing.¹⁹
Traumatic injuries
In the case of traumatic wounds, such as cuts or lacerations, collagen wound dressings provide protection and promote tissue regeneration. They serve as a scaffold for cell migration and support the restoration of skin integrity.
Second degree burns
Second-degree burns require careful wound care. Collagen wound dressings help to accelerate healing by creating a moist wound environment and modulating the inflammatory response. They also reduce the risk of infection and promote the formation of new tissue.
Use for skin grafts and donor sites
After skin grafts or donor sites, collagen dressings support healing by promoting cell proliferation and creating a suitable environment for tissue regeneration. They help to maintain the integrity of the transplanted skin and shorten the healing time.²⁰
Advantages of collagen wound dressings compared to conventional dressings
Promotion of a moist wound environment
A moist wound environment is crucial for optimal healing. Collagen wound dressings absorb exudate and keep the wound moist, which promotes cell migration and accelerates healing.
Reduction of scarring
By supporting the natural healing processes and promoting proper collagen formation, collagen wound dressings help to minimize scarring and improve skin texture.²¹
Biocompatibility and resorbability
Collagen is a natural component of the human body, which increases biocompatibility and minimizes the risk of rejection reactions. In addition, collagen wound dressings are absorbed by the body, which reduces the need for frequent dressing changes.
Minimizing the risk of infection
Collagen wound dressings act as a barrier against microorganisms and can reduce the risk of infection. Some products also contain antimicrobial substances that further increase their effectiveness against infections.
Contraindications and precautions
Unsuitable wound types for collagen dressings
Not every wound benefits from collagen dressings. Caution is required, particularly in the case of dry necrosis and third-degree burns. In such cases, the application of collagen may not only be ineffective but may even hinder the healing process. The use of collagen wound dressings should also be avoided in cases of active vasculitis. In addition, caution is advised in the case of known allergies to animal collagen, particularly from bovine or porcine sources. Although most products are well tolerated, allergic reactions can occur in rare cases.
Combination options with other therapies
Modern wound care increasingly relies on combined therapies to maximize the chances of healing.
Integration with antimicrobial substances
Collagen dressings can be combined with antimicrobial substances to fight infection and promote healing. One example of this is the combination with silver, which has an antimicrobial effect. Such combination products are particularly helpful for infected wounds.
Use in combination with growth factors
The combination of collagen with growth factors, such as platelet-rich plasma (PRP), can promote cell proliferation and tissue regeneration. These therapeutic approaches show promising results, particularly in chronic wounds that do not respond to conventional treatments.
Use together with modern technologies such as cold plasma
An innovative combination is the use of collagen wound dressings with cold plasma. Cold plasma has an antiseptic effect and promotes microcirculation, while collagen creates a moist wound environment and serves as a scaffold for cell migration. This synergistic effect can accelerate the healing of chronic wounds.
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Conclusion
Collagen wound dressings are a valuable tool in wound care which, when used correctly, support healing and improve quality of life. However, it is important to consider the specific characteristics of the wound and possible contraindications. The chances of healing can be further improved by combining it with other therapies, such as antimicrobial substances, growth factors or cold plasma. Talk to your doctor or wound expert to find the right therapy for you.
Bibliography
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