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Hyalofill: a new product for chronic management Mike Edmonds, Ali Foster

Introduction Article points TM Hyalofill has been launched recently as a wound care treatment for Hyalofill is a TM the management of chronic . Hyalofill consists of HYAFF , 1new product for a derivative of hyaluronic acid. The effects of Hyalofill may the management of be attributed to its tissue organising role and its remarkable chronic wounds. hydroregulatory properties, which help to produce a moist environment conducive to wound healing. Hyalofill is 2available in dressing or rope form. yalofill is a new wound care HA has an identical structure in all treatment for the management of and is completely conserved through The active chronic wounds, including diabetic evolution. Hence, it is of fundamental 3ingredient of H biological importance. Hyalofill is hyaluronic foot ulcers. It is a cream-coloured non- acid. adherent fleece which is placed in direct contact with the wound bed of an Hyalofill in use Hyaluronic acid or can be used to lightly pack sinuses. It is Application of HA to human chronic 4is a highly conserved available either as a flat sheet (Hyalofill-F) wounds, such as venous leg ulcers, has molecule occurring or as a rope (Hyalofill-R). been shown to promote healing (Ortonne, in many species, with 1996). multiple functions. Structure and function In its natural state, HA is a gel that is difficult Hyalofill is made of a unique biomaterial to process and sterilise. It is degraded Hyalofill may called HYAFF. This is a stable biocompatible in vivo and breaks down rapidly when 5be more useful for derivative of hyaluronic acid (HA), a major applied to wounds. To increase stability, ulcers complicated by component of the . HA HYAFF was produced from HA via a sinuses and fistulae and is a linear polysaccharide that can absorb chemical esterification reaction linking it to deep exudating wounds. up to 3000 times its own weight in water; a benzyl alcohol. When HYAFF comes into it is nature’s moisturiser and the body’s contact with serum of wound , a Key words hydroregulator. Other properties include hydrophilic gel is produced. The gel overlays l Hyalofill free radical scavenging. HA is present in the wound and creates an HA-rich tissue l Hyaluronic acid many tissues and its functions include: interface, thereby providing a moist wound l Chronic wounds l Facilitation of growth and movement of environment conducive to granulation and l Sinuses healing. Hyalofill is 75% esterified and is l Cushioning in the eyes presented in the form of a non-woven fleece. l Lubrication in the synovial fluid HYAFF is broken down to HA and benzyl l Role in cell mitosis and migration alcohol; the latter is metabolised to hippuric l Control of extracellular matrix acid and excreted in the urine. hydration and osmoregulation (Chen and Hyalofill is straightforward to use. It can Abatangelo, 1999) be stored in the clinic cupboard and used l Regulation of . as needed. Hyalofill should only be applied , an essential step in the to clean wounds; necrotic and sloughy natural process of wound healing, is strongly wounds should therefore be debrided before induced by degradation products of HA application. (West et al, 1985). Once has been controlled and HA may play a critical role in influencing any obviously dead bone removed, the Mike Edmonds is the location of networks (Fienberg sinus can be lightly packed with HYAFF to Consultant Physician and Ali Foster is Chief Podiatrist at and Beebe, 1983). stimulate closure. King’s College Hospital, London

The Diabetic Foot Vol 3 No 1 2000 29 HYALOFILL: A NEW PRODUCT FOR CHRONIC WOUND MANANAGEMENT

Excised metatarsal head. Hyalofill applied to wound. Healed wound, after treatment.

The wound site should be cleaned and group, there were 9 ulcers with sinuses and the surrounding should be dry. Hyalofill 9 with bone exposed. In the active group is placed onto the surface of the wound and 12 of the 13 sinuses healed compared with covered with a sterile secondary dressing. only 1 of 9 in the control group (P<0.01). In the authors’ practice, a secondary foam In the active group, 10 of the 15 ulcers dressing has been used for the diabetic foot. healed, compared with 3 of 15 in the The interval between dressing changes control group (P<0.05). Thus, HYAFF will depend on the amount of exudate application resulted in a higher degree of produced and the stage of wound healing. closure of sinuses and improved healing of In the authors’ practice, it is standard to indolent neuropathic ulcers. lift the secondary dressing daily to assess Hyalofill is now available in the UK. progress in the wound. Ideally, Hyalofill Although evidence on its use in diabetic Page points should be applied every three days to maintain foot lesions is limited and more research an HA-rich tissue interface, although in an is needed, early clinical experience suggests Frequency of outpatient setting a weekly change may be that it may prove useful for the treatment changing Hyalofill 1 appropriate. When changing the wound of ulcers complicated by sinuses and dressings depends on the n amount of exudate dressing, residual Hyalofill is easily removed fistulae, and deep exudating wounds. by irrigating the wound with sterile saline. produced and stage of Hyalofill and HYAFF are registered trademarks of Fidia healing. Advance Biopolymers srl. E.R. Squibb, ConvaTec are Clinical evidence on Hyalofill licensed users. Hyalofill has Recent studies have shown that pre­- Chen WYJ, Abatangelo G (1999) Functions of recently been 2 treatment of full-thickness wounds with an hyaluronan in wound repair. Wound Repair and launched in the UK. esterified HA results in a better organised Regeneration 7: 79–89 and vascularity, with evidence of Fienberg RN, Beebe DC (1983) Hyaluronate in vasculogenesis. Science 220: 1177­–9 Although evidence on angiogenesis (Navsaria et al, 1998). Foster AM, Bates M, Doxford M, Edmonds ME (1999) 3the use of Hyalofill In a recent randomised controlled study, The treatment of indolent neuropathic ulceration in diabetic foot lesions of the diabetic foot with Hyaff. Diabetic Medicine HYAFF was used in patients with : S94 is limited, early clinical 16 and indolent neuropathic ulcers (Foster et Navsaria HA, Harris P, Dona M, Bigon E, Duca M experience suggests that (1998) Hyalofill significantly improves the take rates it may be useful in the al, 1999). Of 30 patients in the study, 15 of cultured . Poster at European Tissue received HYAFF plus standard treatment Repair Society Meeting (August 1998) treatment of ulcers Ortonne JP (1996) A controlled study of the activity complicated by sinuses (active group), and 15 received standard of hyaluronic acid in the treatment of venous leg and fistulae, and deep treatment alone (control). In the active ulcers. Journal of Dermatological Treatment 7: 75–81 West DC, Hampsom LN, Arnold F, Kumar S (1985) exudating wounds. group, there were 13 ulcers with sinuses Angiogenesis induced by degradation products of and 13 with bone exposed. In the control hyaluronic acid. Science 228: 1324–6

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