OVERVIEW:
- Different Types of Collagen
- Clinical Applications
- Wound Types & Healing Phases
Types of Collagen in Wound Care
| Collagen Type | Characteristics | Common Sources | Wound Application | Ideal Wound Tissue Type | Best Used For |
|---|---|---|---|---|---|
| Type I | Most abundant in skin, bone, tendons | Bovine, porcine, human | Sheets, powders, gels | Granulation tissue, epithelializing tissue | Full- or partial-thickness wounds with healthy wound bed |
| Type II | Found in cartilage | Avian, bovine cartilage | Rarely used topically | Not applicable (cartilage-specific) | Joint/cartilage repair (not dermal wounds) |
| Type III | Early granulation matrix; elastic Often co-expressed with Type I | Included in dressings with Type I | Fresh granulation tissue, early-stage wounds | Early wound healing, pediatric wounds, fragile skin | |
| Type IV | Found in basement membranes | Endogenous (not in topical products yet) | Experimental matrices | Basement membrane zone in regenerating epidermis | Not in clinical use yet; studied in skin substitutes |
| Type V / VII | Regulatory role in fibrillogenesis and anchoring fibrils | Limited use | Under study for bioengineered skin | Epithelial-dermal junction, anchoring fibrils | Potential for future grafting and engineered skin |
Forms of Collagen in Wound Products
| Form | Clinical Use | Ideal Tissue | Brand Examples | Notes |
|---|---|---|---|---|
| Sheet Collagen | Shallow wounds, granulating | Granulation, epithelializing | Fibracol® Plus, Puracol®, ColActive® Plus | Maintains moist wound healing |
| Powder Collagen | Tunnels, undermined wounds | Moist granulation | Medifil®, Helix3®, Procellera® | Good for irregular wounds |
| Hydrolyzed Collagen | Chronic, stalled wounds | Stalled granulation | CellerateRX®, Skintemp® Hydrolyzed Collagen | Smaller peptides stimulate healing |
| ORC/Collagen | High MMP environment | Inflamed/chronic tissue | Promogran Prisma®, Collagenase Santyl® (with enzymatic debrider) | Great for DFUs, VLUs |
| Antimicrobial Collagen | Colonized or infected wounds | Granulation/slough | Biostep Ag®, Puracol Ag+®, Silverlon® Collagen Matrix | Combines collagen + silver or PHMB |
| Bioengineered Skin | Deep, chronic, or non-healing ulcers | Healthy granulation | Apligraf®, Integra® Dermal Regeneration, Dermagraft® | Require clean wound bed; costly |
When to Use Collagen in Wound Healing
| Wound Phase | Goal | Use Collagen If… |
|---|---|---|
| Inflammatory Phase | Control MMPs, inflammation | Wound is chronic, stalled, high in MMPs (e.g., diabetic ulcers) |
| Proliferative Phase | Stimulate granulation, angiogenesis | Wound is granulating, partial/full-thickness |
| Remodeling Phase | ECM remodeling | Less collagen needed; focus shifts to epithelialization |
Ideal Wound Types for Collagen
| Wound Type | Use Collagen? | Preferred Form |
|---|---|---|
| Diabetic Foot Ulcers (DFUs) | Yes | ORC-collagen, powder, sheet |
| Venous Leg Ulcers (VLUs) | Yes | Sheet, ORC-collagen |
| Pressure Injuries (Stage 3-4) | Yes | Powder or sheet, possibly with silver |
| Surgical Wounds (Dehisced) | Yes | Sheet or powder |
| Burns (Partial thickness) | Sometimes | Bioengineered skin with collagen |
| Infected wounds | Cautious | Antimicrobial collagen |
| Necrotic/Sloughy wounds | No | Debride first |
PRODUCT EXAMPLES FOR TISSUE TYPE
| Wound Tissue | Use Collagen? | Product Examples |
|---|---|---|
| Granulation | Yes | Fibracol Plus®, Promogran®, Apligraf® |
| Light slough | Yes, post-debridement | Promogran Prisma®, Puracol Ag+® |
| Necrotic/eschar | No | Must debride first |
| Epithelializing | Yes | ColActive® Plus, Integra® |
| Dry wound | No | Add hydrogel if needed |
| Hypergranulation | Caution | Debulk first; reassess collagen need |
Contraindications / Precautions
- Do not use on dry wounds (collagen needs moisture)
- Avoid in wounds with eschar or heavy necrosis
- Caution with allergy to bovine or porcine products
- Some products may be contraindicated in third-degree burns
Evidence-Based Tips
- Use ORC-collagen when protease activity is suspected (common in chronic wounds).
- Combine with NPWT in deep wounds to promote granulation.
- Collagen can be layered with hydrocolloids or foams to maintain moist healing.
- Collagen use should be reevaluated every 7–14 days—if no progress, reassess for infection, ischemia, or other barriers.