Enzymes for wound debridement, trypsin, elase, and granulase are commonly used in the wound healing ABT-737 cost process. Nathan et al.30 investigated the effect of trypsin and suggested that enzymes are a natural part of host defenses in the wound-healing process and that application of enzymes could potentially aid in the wound-healing process and the proteolytic

activity of enzyme is supportive to digest the dressings in the burn wound. This study also concluded that wound enzyme activity and bacterial contamination are not related. Elase, or fibrinolysin and deoxyribonuclease, has been used in everything from treatment of monilial vulvovaginitis to chronic leg ulcers and burn wounds.31 In cases in which the use of elase has been reported to facilitate and extend the necrotic process, its use is selleck highly contraindicated.32 Debriding preparations presently available must be used with caution as bacteremia has been reported in human patients after enzymatic debridement.33 A live yeast cell derivative is a water-soluble extract of yeast reported to stimulate angiogenesis, epithelialization, and collagen formation.34 It has been connected with improved wound healing in dogs. However, in horses, it prolonged wound healing by delaying wound contraction

and resulted in excessive granulation tissue formation.32 Honey has many potentially useful properties, including broad-spectrum antimicrobial activity, anti-inflammatory

action, and stimulation of new tissue growth.35 Even though the exact mechanisms of honey’s bacterial inhibition are unknown, possible mechanisms include osmotic action, low pH, its viscous nature, and production of hydrogen peroxide.36 A review of randomized controlled trials involving honey in superficial burns and wounds concluded that confidence in honey as a useful treatment for superficial wounds and burns was low, although there appears to be some biological plausibility for its use.37 See other topical agents in Figure 2. Silver therapy, in principle, has many benefits, such as (1) a multilevel antibacterial effect on cells, which considerably reduces the organism’s chances of developing resistance; (2) effectiveness against Uroporphyrinogen III synthase multi-drug-resistant organisms; and (3) low systemic toxicity. However, silver compounds such as silver nitrate and silver sulfadiazine are used for topical applications because they may be neutralized by anions (chloride, bicarbonate, and protein) in body fluids or cause cosmetic abnormality (argyria, or blue-gray coloration) on prolonged use, and they can arrest the healing process via fibroblast and epithelial cell toxicity. Despite these shortcomings, silver sulfadiazine is the most popular topical antimicrobial silver delivery system in use because safer alternatives are unavailable.